Circle Medical - South Carolina Collaborating / Supervising Physician MD / DO

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Collaborating Physician Questionnaire

Select all the states you are ACTIVELY licensed in:✱
- CA
- FL
- NY
- IL
- PA
- AZ
- DC
- VA
- TX
- AL
- AK
- CO
- CN
- DE
- IA
- IN
- KS
- KY
- MA
- MD
- ME
- MO
- MS
- NE
- NJ
- NM
- NV
- OK
- OR
- SC
- SD
- TN
- UT
- VT
- WA
- WI
- WV
- WY
Select all the states you have active DEA(s) with Schedule II in✱
- CA
- FL
- NY
- IL
- PA
- AZ
- DC
- VA
- TX
- AL
- AK
- CO
- CN
- DE
- IA
- IN
- KS
- KY
- MA
- MD
- ME
- MO
- MS
- NE
- NJ
- NM
- NV
- OK
- OR
- SC
- SD
- TN
- UT
- VT
- WA
- WI
- WV
- WY
List any additional states you are currently licensed to practice in (or N/A):✱
Do you have a minimum of two valid DEAs with all schedules (including schedule 2N)?✱
- Yes
- No
- Pending
Which state do you permanently reside in?✱
How many years experience do you have working within a primary care setting?✱
- 0-1
- 2-4
- Over 5 years experience within primary care
- Over 5 years experience combined in primary care and emergency medicine
- I have over 2 years of medical experience, but NOT in primary care
We have very high demand and are eager to get great candidates started swiftly. How soon would you be available to start onboarding and collaborating with a cohort of midlevels?✱
- I need to move things around, but I can start working with at least 1 mid-level per week right away.
- I can start within the next week.
- I can start within 2 weeks .
- I can start tomorrow!
- I can't get started until over 30 days out.
Our EMR systems requires a computer that is either Mac (MacBook or iMac), or PC with Windows 10 PRO, or Windows 11. What type of computer do you plan on using to access our systems??✱
- Mac (MacBook or iMac)
- Windows based PC with Windows 10 PRO or Windows 11 OS
- Windows based PC, but not sure which OS it runs
Which Circle Medical team member referred you to this opportunity (first and last name)?✱
Briefly describe what has drawn you to apply for this role?:✱

South Carolina Collaborating / Supervising Physician MD / DO - Telemedicine Primary Care

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Collaborating Physician Questionnaire

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