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Scan & Heal Provider Onboarding

Welcome to Scan & Heal! Thank you for joining our Pediatric Development Directory. Please complete this short intake form so we can build your profile and help local families connect with you.

1. Practice/Clinic Name

2. What is your specialty?

3. Practice Address

4. Practice Email

5. Primary Contact Person

6. Public Phone Number

7. Website or Google Business Profile Link

8. Upload Your Introduction Video

9. Appointment Preference

10. Recording a short video introduction is required for your Scan & Heal listing. Are you open to recording a short video introduction (vertical 9:16 format, Instagram/TikTok style, under 60 seconds)?

10. Recording a short video introduction is required for your Scan & Heal listing. Are you open to recording a short video introduction (vertical 9:16 format, Instagram/TikTok style, under 60 seconds)?

Yes

Please note: Every provider must submit a short intro video so parents can connect with you more personally.

Scan & Heal Provider Onboarding

1. Practice/Clinic Name

2. What is your specialty?

3. Practice Address

4. Practice Email

5. Primary Contact Person

6. Public Phone Number

7. Website or Google Business Profile Link

8. Upload Your Introduction Video

9. Appointment Preference

10. Recording a short video introduction is required for your Scan & Heal listing. Are you open to recording a short video introduction (vertical 9:16 format, Instagram/TikTok style, under 60 seconds)?

👉 Please complete your first month’s payment here to secure your spot