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Available Forms

Add Link to Web Page AJB Use Only-Neurology Task AJBMD Video Room Notification AJBMD-Nurse Ready for Neurology Case AJBMD-Quick Mobile Text from Home Page Apractis Clinic Library Access Request Confirm Updox Login Family Available for Consult Info Now Family Contact Information General Neurology Request-with CCC contact Go To Assist Code Request NeuroDox--Create New User within Virtual Clinic Notify Andrew Barbash, MD that Patient is Ready NowDox-ED Neuro Triage Form NowDox-Nurse Ready for Neurology Case Nurse/Care Manager Secure Message for Andrew Barbash, MD Other Hospital or Facility Neurology Advice (Physician/Mid-Level Use Only) Patient/Family Caregiver Registration 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 Radiologist Report of Neuro Imaging Secure Messaging Registration with Andrew Barbash, MD Setup Zoom Room Notification Form ShareFile Secure Folders Registration SOC CCC GN Intake Form SOC CCC-Message for Dr Barbash TEST-Acute Stroke Quick Intake TEST-Neuro 911-Stroke but TPA less likely TEST-Neuro 911-TPA Exclusion List TEST-Neuro 911-TPA Probable TESTING-General Neurology Request TESTING-Hospital Neurology Request-NeuroDox Form TESTING-Neurology Followup Updox Clinician Invite Request-General Neurology Updox Connect Request Updox Healthcare Professional Registration Updox User Login Request-SOC Physician VC-Colorado-Centura Teleneurology Message Form (Physician/Mid-Level Use Only) VC-Florida-(Physician/Mid-Level Use Only) VC-Holy Cross Clinics (first time user) VC-Holy Cross Clinics (Returning User) VC-Maine VC-Massachusetts-Neurology VC-Neurology-Curbside Advice VC-Neurology-Lake Norman Clinic VC-North Carolina VC-Virginia (Physician/Mid-Level Use Only) Virtual Care Primary Care Patient Registration Virtual Clinic HelpDesk Virtual Clinic-Request New Member Invite Request Entry to My Zoom Video Room-AJBMD Virtual Care Request (Physician/Mid-Level Use Only) 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

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

Reason for Registering

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

Authorization and Verification

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