Request an Appointment Request an Appointment ******NEED TO BE SEEN TODAY? SEE OUR HOME PAGE FOR DATES AND TIMES FOR OUR EXTENDED HOURS CLINIC.****** Name First Name * Middle Name Last Name * Date of Birth Daytime Phone * Evening Phone Email * Select a Physician or Specialty Physician Abid Shah, M.D. Ada Lopez-Mendez, M.D. Alan Gasner, M.D. Ashley Peñaloza, APRN Maria Martino, M.D. Carey E. Coco - APRN Clinton R. Hall, M.D Crystal E. Ingle, APRN David Lipschitz, D.O. David Speyerer, M.D. Lara Devero-Williams, APRN Dorothea Thompson, APRN-C Lorraine Simonds, M.D. Elizabeth Griffin, M.D. Garrison Christian, M.D. Haldane Porteous, M.D. Heather Perry, APRN James E. Koon, D.P.M. John McGetrick, M.D. Jorge Dopico, D.P.M. Jose Martinez-Salas, M.D. Joseph Mancini, M.D. Kyle Pochcial, M.D. Laura Mackley, P.A.-C Lisa Jardine, M.D. Lucien J. Parrillo, M.d., MPH, FIPP Maria Pochcial, M.D. Mark Shabla, M.D. Mary De Sena, M.D. Maurice McCarthy, M.D. Michael Keown, M.D. Michele Murphy, NP-C Rakesh Choubey, M.D. Richard J Honer, M.D. Richard LaCalamito, D.O. Richard Radocha, M.D. Ronald Ford, M.D. Roxanna Ford APRN-C Roya Ghorsriz, D.O. Tiffney Martin, APRN Tristan Harrison, M.D. Vriti Advani, M.D. William Cooper, D.O. Willie K Jones, M.D. Wojtek Aronski, M.D. Yerania Rodriguez, M.D. Zahily Fals, M.D. Physician Specialty Addiction Medicine Allergy / Immunology APRN Colon & Rectal Surgery Dermatology Endocrinology Family Practice Gastroenterology General & Bariatric Surgery General, Breast & Vascular Surgery General & Biliary Surgery General & Vascular Surgery Gynecology Internal Medicine Interventional Cardiology Interventional Spine Nephrology Obstetrics and Gynecology Ophthalmic Plastic & Reconstructive Surgery Opthalmology Orthopedic Surgery Plastic & Reconstructive Surgery Podiatry Pulmonology Rheumatology Sports Medicine Specialty Reason for Appointment * No other services should be requested here. Disclaimer THIS FORM SHOULD NOT BE USED TO COMMUNICATE WITH THE PHYSICIAN'S OFFICE. ANY REQUESTS FOR SERVICES OTHER THAN TO MAKE AN APPOINTMENT WILL NOT BE PROCESSED. PLEASE USE OUR PATIENT PORTAL OR CALL YOUR PROVIDER FOR NON APPOINTMENT SERVICE REQUESTS. This form allows one appointment request per submission. Please submit a form for each appointment requested. Please allow 24 hours or one business day for us to contact you. The information provided will remain private and confidential and will not be placed in your medical record – it will only be used by our administrative staff to assist you with scheduling your appointment. This form should be used for NON URGENT appointments only. If you need immediate assistance, contact your provider’s office directly. Please provide a valid phone number as Gessler Clinic will follow up via phone call to confirm your appointment time and any additional information that is needed.