135 Spring Street, 2nd Fl • NYC 10012
Tel. 212.219.1187 • Fax 212.219.1538
home home home home home home home


Telemedicine Appointment Request

During these unprecedented times of the current COVID-19 pandemic, we are dedicated to remaining available to our patients and their medical needs. In an effort to support social distancing, and keep our patients, families and staff healthy, we are launching telemedicine visits starting March 23

Please be aware that telemedicine has its limitations, and is not appropriate for visits that require a physical exam such as prenatal care, procedures, etc.

Some examples of appropriate telemedicine conditions include: urinary tract infection, vaginitis, post op check, preconception, contraception and menopause counseling, infertility evaluations.

Also, if we determine at the time of your telemedicine visit that you require an in office evaluation, we will still be billing the insurance and/or charging for the telemedicine visit as a service has been rendered.

Please call our office or email the practice through the patient portal to schedule this visit. Upon completion of the visit, we will submit a claim to your in network insurance company for reimbursement. If your insurance does not reimburse for telemedicine, or your insurance is a plan we do not participate with, you will be charged an out of pocket expense of $150

We will be using Doxy.me for these consults. You will receive an invite by text or email before your appointment time.

We ask that you sign below an agreement of the above terms. Once it is submitted, we will be happy to schedule your visit.

Thank you for your patience and cooperation during this difficult time, and we look forward to keeping you and your families healthy.

Stay Safe,
Spring OB GYN



Last Name:
First Name:
Contact Number: ( )
I agree to the above terms for a telemedicine visit in this time of COVID-19 crisis.: Yes
 
 
*Please note that this form will be sent to us securely. All information is kept confidential and private.

Please allow 24-48 hrs for us to process your request. If you do not hear from our office within this time frame please call 212.219.1187

HEIDI FLAGG, MD • BRINA MALDONADO, MD • DANIELLE FELDMAN, MD • LINDA CHO, MD • ELIZABETH RODGERS, MD •  LEIGH ANN WADE, MD • VICTORIA ONBREYT, MD • JAMIESON GREENWALD, MD • LAUREN LESE, CNM • MARY MILLER, CGC • MINDY VALENTI, FNP-C • NICOLE MEADE, CNM, NP

Copyright © 2019 Spring Ob/Gyn, PC | HIPAA Policy and Privacy