Andrew Barbash, MD - Publicforms

Available Forms

Apractis Clinic-Request New Member Invite Barbash Network-Register Consult Documentation-Neurology-Andrew Barbash, MD Consult Request-Community Clinic Consult Request-Putnam Hospital (NY) Consult Request-Univ of Md St Josephs Copy of Join Us-Including Specialties Family Available for Consult Info Now NeuroDox-Request a Mobile Video Link NowDox Request Confirmation NowDox-Add Room Link Other Hospital or Facility Neurology Advice (Physician/Mid-Level Use Only) Patient Confirm Video Visit Time Patient Info Request Send to Provider Patient/Family Caregiver Request Virtual Care PERSONAl/MY FAMILY ONLY-From Ellie to Andy Physicians/Mid-Levels Secure Message for Andrew Barbash, MD Podio Access Request Schedule a Virtual Care Visit with AJBMD ShareFile Secure Folders Registration Team Meeting TESTING-General Neurology Request TESTING-Hospital Neurology Request-NeuroDox Form TESTING-Neurology Followup Virtual Care Primary Care Patient Registration WAFCC-Admin Contact Form Waiting Room-Dr Vu Waiting Room-Test Specialty WebForm-Add Your Hospital to Our List WebForm-Availability-Neurologist WebForm-Consult Request for Dr Barbash-Neurology Telemedicine WebForm-Meet Dr Barbash by Video WebForm-Register with Barbash Virtual Care WebForm-Request to Enter Webinar Meeting WebForm-Specialist Registration for Barbash Virtual Care WebForm-Updox ID Request for Barbash Neurology Team WebForm-Waiting Room-Neurology Request Entry to My Zoom Video Room-AJBMD Web Message for Dr Barbash

Virtual Care Primary Care Patient Registration

This is for patients referred by a primary care physician/provider who is part of the virtual care program (see below).

Your Contact Information

Your Name *

Date of Birth (MM/DD/YYYY) *

Mobile Phone *

This must be a mobile phone at which I can contact you by text if needed.

Email *

Reason for Registering

Reason for consultation *

Let me know the specific neurologic symptoms you are having and any questions

Authorization and Verification

Agreement to Participate in Virtual Care

By checking this box I am stating that I have been referred for virtual care specialty services by my primary care provider and that I will make a followup appointment with him/her afterwards. I am also confirming that I am fully responsible for the accuracy of any information provided.

How to Provide Additional Documents or Files

If you have any notes, documents, reports or medical images....you can email them directly to me at abarbash@myupdox.com or fax directly to me at 888-905-3830

* Required field