Patient Registration Form

By completing this intake form, your selected Doctor can get an idea about your health issue to prepare for your virtual visit. The confidentiality of your health information is protected in accordance with federal protections for the privacy of health information under the Health Insurance Portability and Accountability Act (HIPAA). This form is encrypted and secured by AeroDPC (a subsidiary of Heint Health) for the collection and storage of ePHI (electronic personal health information). 

Step 1: Fill up this form with your health issues

Step 2: Check your email for instructions to sign up for your membership

Step 3: Get access to your patient portal & book an appointment with your preferred Specialist

Step 4: Click on the meeting link at the time of your telemedicine appointment (we will remind you ahead of time)

Incomplete forms will not be processed, you may be contacted to complete any missing data. For any queries, reach out to us at connect@viosapp.com or visit our homepage.