PhysioAge: PhysioAge Analytics Enrollment

Primary Contact Details

Role*

A Provider is typically an MD, DO, PA or NP. The name of the provider is displayed on the patient report. Providers typically use the system to look up results and review results with patients. A Caregiver is any non-provider user. Caregivers typically create visits and enter results.

*First Name

*Last Name

Honorific suffix

MD, DO, NP, PA, etc..

*Email

Plan Details

Choose Plan*

Learn more about plans by clicking here. Plus versions include a free CONNEQT Pulse device every two years with CardioAge, and Enterprise Support (overnight replacement) from Cardiex.

Site Details

*Name

This is the name that will appear in the patient portal and be the name of the sender when we email links to patients. It will also be used in breadcrumbs and other places throughout the site.

This will be the email address of the sender when we email links to patients

Localization Preferences

Language preference*

Date preference

Example: MDY = June 12, 1968

Unit preference*

Example: Imperial uses inches, SI uses centimeters

Logo

Upload a high-resolution logo file to be featured on reports and your Patient Portal. (Image size: Minimum 150x150 pixels, Image File: png, jpg/jpeg or gif). Don’t have a suitable logo file handy at the moment? Just send it to support@physioage.com when you do.

Data Sources

We can configure your account to collect data from diverse sources. Select the panels you'd like to include with every visit. There is no additional charge per panel, but some panels require special equipment to collect their required parameters. To minimize clutter, only select the panels you use on a regular basis. Additional panels can be easily added to any visit. Click here for a complete list of panels

Blood and Urine

Default Panels

Select...

Optional Biomarkers

Default Panels

Select...

Electronic Lab Interfaces

Provide your Quest and Labcorp account numbers to import results electronically. Additional complimentary interfaces can be configured at a later time, after you establish your additional accounts. See Account Setup guide for full details on establishing your additional accounts.

Quest Account Number

Labcorp Account Number

Referral and Publicity Information

*Address

*City

*State

*Postal Code

Country

*Phone

This number will be provided to patients and used by PhysioAge in case we need to contact them about site outages.

Website

Website must start with either http or https, like 'https://www.myclinic.com'

Other Info

What EMR are you using?

How did you hear about us?

Conference

Newsletter

Internet Search

Magazine

Television

Friend

Others

Anything else you'd like to add?

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