Radiologist Application

Communicate with TeleRadDirect as we Match you to 1-2 of >60 Network TeleRad Companies (more efficient, less calls/emails) Five (5) Mandatory fields are indicated with asterisks*. We’ll respond by next Business Day. Thank You!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Upload CV*

Max. file size: 128 MB.

States Hold Licenses

Please use two letter abbreviations….MO for Missouri, for example

Please indicate any State Licenses in pending status

Type N/A if none

Fellowship Subspecialty

Type N/A if none

Previous Teleradiology Experience

Type N/A if none

Desired hours per week (approximate)

Desired weeks per year (approximate)

Availability (Weekdays, Weekends, Evenings, Nights)

Available Start Date (approximate)

Citizenship or Visa Status*

Other Considerations

Question or Info Request