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Avatar Panel Discussion
Curation Form
This form is for participation in the AI Wellness Founding Cohort Digital Avatar Panel Experience.
Selected clinicians, practitioners, and experts will contribute to:
Live clinical panel discussions
Digital Avatar content creation
AI-assisted knowledge capture
Founding Cohort ecosystem integration
This is a curated, invitation-based collaborative platform designed to translate clinical expertise into interactive and digital learning experiences.
Avatar Panel Discussion Curation
BASIC INFO
Full Name
*
Full Name
First Name
First Name
Last Name
Last Name
Phone
*
Email
*
Professional Credential
*
Specialty
Practice & Organization
*
Website
PANEL ASSIGNMENT
Assigned Topic Area(s)
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Cardiovascular & Metabolic Longevity
Microbiome & Gastrointestinal Medicine
Respiratory Physiology & Nitric Oxide Science
Precision & Longevity Medicine
Hormonal & Sexual Health Medicine
Oral-Systemic & Inflammatory Medicine
Predictive & Preventive Medicine
Regenerative Dermatology & Trichology
Musculoskeletal Optimization & Performance Medicine
Cellular & Immune Optimization
Neurocognitive & Stress Optimization
Financial Stress & Physician Health
Advanced Diagnostics & Imaging
Metabolic & Nutrition Science
Reproductive & Developmental Medicine
Hepatic & Detoxification Science
Retinal & Neuro-Ophthalmology
Sleep Medicine & Vagus Nerve Science
Single select
Your role(s) in the panel discussion
*
Primary Clinical Voice
Supporting Clinical Contributor
Systems / Integration Contributor
Moderator (Assigned by AI Wellness Team)
Multi select
CLINICAL PERSPECTIVE
Your Core Area of Expertise
*
Key Clinical Approaches You Use
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Most Common Patient Presentations You See
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What Problem Do You Spend Most Time Solving Clinically?
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How Do You Define a Successful Outcome in Your Practice?
DIGITAL AVATAR INTEGRATION
If Your Clinical Knowledge Were Turned Into a Digital Avatar, What Should It Help With?
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Patient education
Clinical explanation
Practitioner training
Case discussion support
Protocol guidance
General health literacy
Other, please specify:
Other, please specify:
Do you have a digital avatar with AI Wellness?
*
Yes, I created my avatar
I signed-up for it, but it still needs to be created
No
What is digital avatar? (need more information)
Top 3 Questions You Are Most Commonly Asked
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Anything You Do NOT Want Misrepresented About Your Work?
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Permission for AI Avatar Use of Your Knowledge
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Yes
Yes, but I'd like to review before use
No
Need more details
PANEL CONTENT DESIGN
3 Key Questions You Recommend for Your Panel Discussion
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One Controversial or Debated Topic in Your Field
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Optional Clinical Case You Would Like Discussed
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One Key Message You Want the Audience to Walk Away With
*
PANEL FORMAT & CONTENT USE
Do You Approve Your Session Being Recorded?
*
Yes
No
Do You Approve Your Content Being Used in AI Avatar Training Systems?
*
Yes
No
I agree my content being used in:
Panel recording
AI Avatar training system
Educational content library
Founding Cohort ecosystem materials
SCHEDULING & PARTICIPATION
By submitting this form
*
I understand that I will be contacted to confirm availability for the panel discussion
DIGITAL AVATAR PRODUCTION NOTICE
By submitting this form
*
I agree to:
- Be contacted for scheduling
- Complete avatar session within production window
- Participate in either in-person or virtual format
- Provide accurate clinical representation
Final Agreement
*
I agree to participate in the AI Wellness Digital Avatar Panel Experience as described above.
Signature
*
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keyboard
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Date
*
Submit
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