Form

Public-facing information

Company name*

Solution name*

Website URL*

COVID-19 Specific Website (if applicable)

Description of Telehealth/Digital Health Offering(s)*

Please limit to one paragraph

Who is this solution for?*

Patients

Clinicians

Your contact information

Please check to confirm that I have the necessary authority to provide this data on behalf of my organization.*

First name*

Last name*

Job Title*

Email*

This will allow other ATA Members and the Public to see your information displayed in a listing of relevant and categorized products and services within the Industry once this is launched.

Please confirm that you would like to be listed in the ATA Member Directory.