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Pre-op Evaluation Scheduling Form


Pre-op Surgical Consultations

Pre-op surgical consultations should, ideally be scheduled no more than 30 days prior to a procedure and no less than three days prior to a procedure.

We encourage surgical scheduling coordinators to utilize this form to initiate appointments for their patients. Our Office will contact the patients to schedule their appointment.

Scheduling coordinators should fax or email demographic information and insurance information to 212-737-2936 or

Make an Appointment

Surgical Coordinators: Please fill out this form, and we will contact your patients for their appointments. Same day or next day appointments must be made with the Office manager.


East Side Primary Medical Care
229 East 79th Street, Suite 1C
Upper East Side

New York, NY 10075
Phone: 680-206-2794
Fax: 212-737-2936

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