Virtual Practitioner Program
Welcome to the Modi Health practitioner platform. This is your virtual office set up.
Please download and complete the forms below and then upload the required documents. Also, please set your schedule below. You can update your schedule at any time.
DOWNLOADS
Practitioner Video SpecificationsModi Release Form – Wellness Practitioner Agreement
For medical doctors please use the following release form:
Doctors-Modi-Release-Waiver-of-Liability-Indemnity-Agreement-1756141
UPLOAD DOCUMENTS
HEAD SHOT
COMPLETED FORM
PROOF OF CERTIFICATION AND/OR LICENSE
PROOF OF INSURANCE
SIGNED RELEASE FORM
W9 TAX FORM
EDUCATIONAL VIDEO AD
*By choosing to upload your video you give us the right to add this video to our membership platform as well as use it in whole or part to advertise.
The timezone displayed is as per your desktop timezone settings.