Request an Appointment

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Terms & Conditions

This form is for general inquiries regarding administrative and scheduling items only. Please do not include any information regarding your medical care. Any information transmitted to NY Neurological Associates P.C. through the submission of this form is not encrypted. Please allow up to 6 hours for a response for an appointment.

Note that this form is not a tool by which you can obtain medical advice or care. However, we would be happy to see you in the office for an evaluation. Please submit an appointment request and call-back number through this form, or please call us at the numbers provided above to schedule an appointment.

Please be advised that we place the highest value on your privacy. Any information received by us through the use of this form will be maintained in accordance with our obligations under applicable privacy and confidentiality laws and regulations. We cannot and will not be responsible for messages not received as a result of incorrect information or blocked accounts.
* First Name
* Last Name
* Email
* Phone
* Zip Code
* Health Insurance
* Current Patient   Yes No
Appointment Details
* Preferred Day
* Preferred Time
* Preferred Office
* Preferred Neurologist

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