Are you 18 years of age or over?✱

Are you legally eligible to work in the U.S.?✱

Will you now or in the future require visa sponsorship for employment?✱

Do you have a relative who currently works at Carbon Health Technologies or Direct Urgent Care?

Have you ever been excluded from participation in any state or federal health care program?✱

Do you have an active and unrestricted California license to practice?✱

Are you willing to undergo a background check in accordance with local law/regulations?✱

TCPA Consent & Privacy: Notwithstanding any current or prior election to opt in or opt out of receiving telemarketing calls or SMS messages (including text messages) from us, our agents, representatives, affiliates, or anyone calling on our behalf, you expressly consent to be contacted by us, our agents, representatives, affiliates, or anyone calling on our behalf for any and all purposes arising out of or relating to your application, at any telephone number, or physical or electronic address you provide or at which you may be reached. You agree we may contact you in any way, including SMS messages (including text messages), calls using prerecorded messages or artificial voice, and calls and messages delivered using auto telephone dialing system or an automatic texting system. Automated messages may be played when the telephone is answered, whether by you or someone else. In the event that an agent or representative calls, he or she may also leave a message on your answering machine, voice mail, or send one via text. You consent to receive SMS messages (including text messages), calls and messages (including prerecorded and artificial voice and autodialed) from us, our agents, representatives, affiliates or anyone calling on our behalf at the specific number(s) you have provided to us, or numbers we can reasonably associate with your account (through skip trace, caller ID capture or other means), with information or questions about your application, loan and/or account. You certify, warrant and represent that the telephone numbers that you have provided to us are your contact numbers. You represent that you are permitted to receive calls at each of the telephone numbers you have provided to us. You agree to promptly alert us whenever you stop using a particular telephone number. Your cellular or mobile telephone provider will charge you according to the type of plan you carry. You also agree that we may contact you by e-mail, using any email address you provide.✱

Did you opt out from Medicare?✱

Are you a Board Eligible or Board Certified Physician?✱

Are you currently in training (Residency or Fellowship)?✱

Does your license have any sanctions or restrictions?✱

Do you have an unrestricted DEA license?✱

How many years of post-residency experience do you have as a Physician?✱

How many years of post-residency experience in Primary Care or Internal Medicine do you have?✱

Which age groups do you have experience seeing?✱