Provider Account Request

This form is for providers who are affiliated with current MAVEN Project partner clinics. If your clinic is not an active partner, but you are looking to become one - please connect with us at info@mavenproject.org.

By completing this form, you will receive a user account for VSee, MAVEN Project’s telehealth platform, with unlimited access to eConsults and video consults across 59+ clinical specialties!

Sal.

First name

Last Name

Please use your work e-mail address.

Mobile number (optional)

Please select your clinic or organization:

Time Zone:

If your clinic has multiple locations, please let us know the name or location of your primary site:

State

I am a:

MDDONurse PractitionerPhysician Assistant

Are you working under the license of a licensed physician?

YesNoPLEASE NOTE: In order to use our services and request a MAVEN Project account, you must be either a licensed physician or a Nurse Practitioner or Physician Assistant working under the license of a physician.

Please enter the name of the physician under whose license you practice:

Sal.

First Name

Last Name

By clicking submit, I attest that the information provided in this form is accurate.

Contact Information