Andrew Barbash, MD - Publicforms

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Waiting Room-Test Specialty

Secure Form to Request Entry into a Provider's Virtual Waiting Room

THIS IS FOR TESTING AND DEMONSTRATION PURPOSES ONLY.....For direct use by nurses, mid-levels, physicians or other healthcare professionals to enter the virtual waiting room for a provider or specialty team. ANY device can be used. This is fully HIPAA-compliant, does not require any software to install and does not require any IT support

Your Name *

First AND Last Name Please

Your Mobile Number (Smartphone) *

We MUST be able to communicate by SMS text to a smartphone for reliable contact.

Clinic, Hospital or Facility *

Where should the room link be sent to? *

My mobile phone

My email address

No preference

You decide if you prefer to do the video meeting from your mobile phone or your computer/tablet

If you selected mobile to connect, skip right to the SUBMIT button

Email (Optional)

IF you will want to meet on your computer or tablet instead of a smartphone, then we can send the link to your email. If that is preferred, then enter your email. Otherwise leave this blank

Comments (Optional)

If you want to provide the patient name or any other relevant information that would be helpful to the visit, this is all secure and arrives in our team inbox.

We will respond with a unique meeting link. This will enter you in a waiting room, we are notified, and then will start the video session.

* Required field