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Patient Data Solutions

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Online Clinic Signup

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You must scroll down thru the entire agreement before you can accept, Clicking here signifies agreement with the above statement. You must sign to proceed.

We need to signup any providers here.

The REQUIRED information for ANY Provider is:

  • Provider Name
  • NPI Number
  • and a signature

For portal access ADD an email address and cell phone.

Cellphones are used ONLY for portal verification, and they will NEVER be available to any third party, or unnecessarily called.

if you are NOT authorized to sign for the provider, the completed form will be emailed for signatures.

this really needs to be a cellphone number we use SMS messaging to provide multiple layers of security and identity verification.

Provider or authorized party to sign here:

ProviderName

NPI Number

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We need to signup any staff here.

You do NOT need to re-enter Provider information here.

The REQUIRED information for general staff:

  • Name
  • and a signature

For portal access ADD an email address and cell phone.

Cellphones are used ONLY for portal verification, and they will NEVER be available to any third party, or unnecessarily called.

this really needs to be a cellphone number we use SMS messaging to provide multiple layers of security and identity verification.

Contact or authorized party to sign here:

ContactName

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File Name File Size File Type

Thank you very much you've successfully registered your office for allergy testing. Should you have any immediate questions, please contact your representative: Paul Haje / (408) 605-4919, within a day or so, you will receive login credentials by email AND SMS with instructions on accessing your Patient Data Solutions portal. Following that, within a few days you will receive testing kits. Each kit contains a blood capture card, lancet and alcohol wipe. We will contact you to schedule an orientation call around the time you receive your kits. Once you have portal access, you will use it to:


  • Access patient reports
  • Print test requisitions
  • Print shipping labels
  • Order additional kits
  • Order Immunotherapy if you've requested that functionality

If you have IT related questions in the meantime please email support@patientdatasolutions.com and yes, there are real people that do respond quickly to questions from that email address
We look forward to being of service to ensure your experience with introducing this test into your practice is beneficial and smooth.

Warmest regards,
Paul Haje