NEW PATIENT INTAKE FORMS
BECOME A NEW PATIENT
Primary Care Physicians or OB/GYN Physicians may choose to fax your Physician Referral Form with supporting documents, and your Insurance Authorization (if required). Your new patient intake forms can be included here.
For your safety and to maximize your visit with your surgeon, all patients are required to complete and submit new patient intake forms 1-2 weeks before your first appointment can be scheduled. It is best if you have already had a routine annual visits with your primary care physician and general OB/GYN physician this year.
STEP 1: CONTACT YOUR INSURANCE
Since insurance varies by region, specialty, and physician, it is recommended that you contact your insurance company to confirm that your insurance plan is accepted and if you will need an insurance authorization to be seen by the specialist.
STEP 2: COMPLETE INTAKE FORMS
Click to download the patient forms underlined in pink below. Print the forms and complete them.
Please include a clear copy of your current ID and insurance cards. To limit the number of visits you will need, it would be wise to include all related lab reports, imaging reports, operative reports, and office records of any previous treatment you have had for your condition.
STEP 3: PHYSICIAN REVIEW
Fax your completed forms to (609) 216 7970. Once received and reviewed, you will be emailed a link to register and communicate directly through your secure patient portal. Request new patient in-person visits here.
STEP 4: TELEMEDICINE VISIT REQUESTS
Click on “Request Telemedicine Appointment” and enter your information. You will then receive an email/txt letting you know your message was received. Our office will respond with a confirmation or option to reschedule to an available time slot. Be sure to check email spam box for your OTP (one time password) if you do not see this in your inbox. In office visits will be scheduled by your doctor as needed during your telemedicine visit.
Welcome back! You may now send and receive messages electronically through your secure patient portal. Click on the “log into your patient portal” button. Enter your email address as your user name. Follow the prompts to reset your password if you have forgotten it.
To request a telemedicine appointment please click “Request Telemedicine Appointment. Enter and submit your information. You will receive a text or email message back when this is received. Our office will respond with a confirmation or a message if the appointment could not be confirmed. Be sure to check your email spam box for your OTP (one time password) if you do not see this in your email inbox.
Dear Prospective Patient,
I chose to become a Urogynecologist because I witnessed first hand the dramatic difference that specialized treatment could have on a lady’s overall wellbeing, confidence, and quality of life.
Pelvic floor disorders are increasingly common. Regardless, they can be complex, disheartening, and limiting to one’s livelihood. Because the impact on each woman varies and each woman chooses to manage these problems in different ways, I believe in a treatment approach that is personalized.
It is my wish to assist patients and their loved ones to participate in their treatment plans by first helping them to understand their symptoms and the relative risks and benefits that come with different surgical management options.
I enjoy my profession and the long lasting relationships I have built with my patients and colleagues. I am dedicated to offering women the highest standards of care in a comfortable, efficient, effective and compassionate manner.
It would be a pleasure to meet you and discuss your concerns. I would encourage you to ask your primary care doctor or OB/GYN for a referral or contact us for a consultation.
Sandy Nosseir, MD, FACOG, FPMRS