Teladoc Health Provider User Registration

Please complete and submit this form to create an Teladoc Health provider user account.

If you are a patient, please contact your healthcare provider for assistance in accessing your virtual consult

First Name

Last Name

Username

Password

Confirm Password

Email Address

Confirm Email

Title

Address

City

State

ZIP/Postal Code

Country

Mobile Phone

Office Phone

Employer

Referred By

Specialty

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Challenge Question

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A verification email will be sent to your email address