Name*
Local phone number
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US phone number
Email address*
Website
Facebook page
Other online media
Address
City(s) & State(s)
Country(s)
List all countries you have worked in
Primary specialty Years of experience
Secondary specialty Years experience
Please list all other specialties
Institution name Country
List all other education
List all credetials and training including outside of your country
List of countries you trained in
Do you currently have American or Canadian patients?? YesNo
How many American patients do you treat per month? YesNo
How many years have you worked with American patients? YesNo
Do you have a facilitator? YesNo If yes
Do you buy online publicity to capture American patients? YesNo If yes List
English website
English facebook page
Online profiles and/or other website you use to get new patients
Do you have online reviews written in English? YesNo If yes
Do you use a crm? YesNo If yes
Is your business registered? YesNo
Is your logo & business name registered? YesNo
Do you manage your online services or does soemone else do it for you? YesNo
How many members in your staff?
How many members in your staff speak 80% english or better?
Name (s) of the person that takes calls from American patients
Does staff wear uniforms? YesNo
Does the facility have a back up power source for emergencies? YesNo
Is the facility shared with other professionals? YesNo
Do any of them already work with medical tourism? YesNo
How close is the nearest hospital? Name of hospital?
How far is the airport?
Do you offer private transpotation? YesNo
Is Uber available in your city? YesNo
Is patient lodging within walking distance? YesNo
Which hotels are near the area and which hotels do you recommend for your American patients?
List the most attractive points of interest in your area
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