TEST – Request for Videos Requested by:(Required) Email from:(Required) Patient Name:(Required) Diagnostic:(Required) Procedure Name(Required) Date of surgery/treatment:(Required) MM slash DD slash YYYY Should this video include x-rays?(Required)YesNoUpload x-ray images(Required)Accepted file types: jpg, jpeg, png, gif.Should this video include any other video footage?(Required)YesNoVideo in Google Drive: Video footage: Drop files here or Select files Max. file size: 50 MB, Max. files: 5. Date of video footage:(Required) MM slash DD slash YYYY Audio by Dr. Badia narrating treatmentMax. file size: 50 MB.Photos to be used in the video Drop files here or Select files Max. file size: 50 MB. Additional detailsPhoneThis field is for validation purposes and should be left unchanged. Δ
