Virtual Coach Directory

Terms of Service: *

I have read and agree to the terms and conditions listed here to be listed on FlexMedStaff website.

Please complete the form below to allow FlexMedStaff to place you on the website/platform as a source for the general population too contact you. There is an annual fee that must paid separately to activate and continue your account with FlexMedStaff. FlexMedStaff, LLC is to be held harmless in the event any action is brought against an individual. patient or facility associated with the use of this platform/website or the interaction between the practitioners and patients or general population. It is the sole responsibility of the users to research and verify the practitioners and users of the platform. FlexMedStaff, LLC only provides a job-board only. FlexMedStaff is not responsible for billing or collection of payment from users other than the practitioners that chose to be listed on the platform. Your information here will not be sold or used with 3rd party vendors.

Name of Contact Person *

First

Last

This will not be shared publically. This is for internal purposes only.

Direct Email of Contact Person *

This will not be shared publically. This is for internal purposes only.

Phone Number of Contact Person *

This will not be shared publically. This is for internal purposes only.

Information below will be placed the Coach directory.

Full Name of Person to be listed on Website *

First

Last

Email Address to be listed on Website *

What is your advanced degree?

MD
DO
Other

What is your specialty?

What is your must advanced degree? *

Please provide the name of the certication course you took for coaching

Upload a professional picture/image of yourself. *

Click or drag a file to this area to upload.

Upload a short video (1-2 minutes) of yourself introducing your services.

Click or drag a file to this area to upload.

If you are unable to upload video then please provide URL so that the video can be linked to website.

If you can not upload video then please provide URL of website (ie: Youtube link)

Description of yourself and your services *

Enter a detailed description of the position.

Type of Coaching (ok to select multiple) *

Name the type of coaching you to if not on the list above (ie: Dance Coach, Billing Coach) *

Provide URL of your website:

https://flexmedstaff.com

Practice Type *

One-on-one sessions
Group sessions
Both one-on-one and group sessions

Do you accept CME dollars? *

Yes
No

Languages Spoken (you can select mutlple) *

What calendar system do you use? *

What calendar system do you use if not listed above? *

How many years of experience coaching? *

Less than 2 years
2 to 5 years
Greater than 5 years

Information below will be placed the Coach directory.

Facility registration for FlexMedStaff is currently in process of development, so please contact us directly for additional questions and registration details at Support@FlexMedStaff.com