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Brick Health Interest Form
Fill out the questionnaire below to register your interest in partnering with Brick Health. We'll reach out with more details once we've expanded to your area.
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Email
*
Your email
Your name
*
Your answer
Practice name
*
Your answer
Practice website URL
*
Your answer
Practice ZIP code
*
Your answer
Number of physicians
*
Your answer
Number of non-physician clinical staff
*
Your answer
Capabilities
*
Check the box if you currently provide the service in your DPC practice
Vitals (pulse ox, BP, HR, height, weight, respiratory rate, temperature)
Auscultation (analog)
Digital auscultation (with audio recording capabilities)
EKG (12-lead)
Cerumen removal via ear lavage
Stool hemoccults
Phlebotomy
Urinalysis (rapid result)
Peak flows
Spirometry
Rapid strep tests
Influenza tests
Monospot
COVID-19 tests
Stool culture
Stool for WBCs
Stool for ova & parasites
Hearing screening
Vision screening
Rapid urine drug screen
Urine microscopy (sample collection for lab)
Urine culture (sample collection for lab)
24-hour urine electrolyte studies (sample collection for lab)
Zio patch facilitation
Obstructive sleep apnea screening (overnight pulse oximeter loan)
Orthostatic vitals
Toenail trimming
Applying compression wraps to lower extremities
TB skin test application
Required
Any concerns or questions?
Your answer
A copy of your responses will be emailed to the address you provided.
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