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

Family Available for Consult Info Now

If Family Members are present who can give a specialist a reliable history about the patient we can skip all other triage and get online with them now.

Patient Information

Name of the Hospital/Facility *

Patient's Name *

Family Contact Information

Family Members Names *

Please let us know the name and relationship of family present

Mobile Phone *

This must be a mobile phone at which you can be easily contacted by text message if needed.

Email *

Relationshp to Paitent *

Patient Directly

Family or Caregiver

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Power of Attorney

Please let me know whether a physician is communicating directly with the patient or with another person on their behalf

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

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