Patient intake consultation

Patient Intake & Case Evaluation

Submit your case for direct surgeon review. Evaluations within 24–48 hours.

Educational Notice: This information is educational only and does not constitute medical advice. It does not establish a physician-patient relationship. Clinical care is provided by independently licensed physicians affiliated with Town Surgery NY PLLC.

How It Works

1

Submit Your Case

Complete the intake form with your surgical history, symptoms, and imaging availability.

2

Upload Imaging

Upload your CT scan or other imaging for direct surgeon review. Instructions provided after submission.

3

Surgeon Review

An affiliated surgeon reviews your case within 24–48 hours and contacts you directly.

4

Evaluation Scheduled

If appropriate, an in-person or telehealth evaluation is scheduled at your convenience.

Prefer to Call or Text?

For Referring Physicians

We accept direct referrals and provide timely case consultation. Please include operative reports, imaging, and relevant clinical history. Select "Referring Physician" in the form below.

Fax: 1-800-555-0101 (HIPAA-compliant)

Case Evaluation Request

All fields marked * are required. Imaging upload instructions will be provided after submission.

Personal Information

Surgical History

Current Symptoms

0/500

Imaging Availability

Secure Imaging Upload: After submission, you will receive instructions for securely uploading your CT scan or other imaging for direct surgeon review. All imaging is handled through HIPAA-compliant secure transfer protocols.

Referring Physician Information (Optional)