Thank you for your interest in participating as a partner in the Cyber-Sight telemedicine program.  In order to enroll in E-Consultation, please complete the partnership application and agreement that can be downloaded from the link below.  This short form provides us with the necessary information to create a personal profile that allows you to access your own private page for sending E-Consultation patients which are then archived for your reference.

You may return this form either by mail at:  520 8th Avenue, 11th floor, New York, NY 10018; or by fax at:  646-674-5598; or by email at:  cyber-sight.consult@orbis.org.  If you wish to return the application by email, but do not have an electronic signature or access to a scanner, a typed signature is acceptable.

If you have any questions or have trouble downloading the form, please contact us at:

cyber-sight.consult@orbis.org for assistance. 

Telemedicine Partnership Application and Agreement (283 KB)