{"id":207,"date":"2019-07-16T07:00:01","date_gmt":"2019-07-16T07:00:01","guid":{"rendered":"https:\/\/livewp.site\/wp\/md\/sirona\/?page_id=207"},"modified":"2026-03-18T16:50:08","modified_gmt":"2026-03-18T16:50:08","slug":"contact","status":"publish","type":"page","link":"https:\/\/nygse.com\/es\/contact\/","title":{"rendered":"Contacto"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"207\" class=\"elementor elementor-207\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-879d232 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"879d232\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bb71bc3\" data-id=\"bb71bc3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b0b0b47 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b0b0b47\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bcfcd52\" data-id=\"bcfcd52\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-e065809 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e065809\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-695e0eb\" data-id=\"695e0eb\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3d72f4 elementor-widget elementor-widget-image\" data-id=\"b3d72f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"940\" height=\"661\" src=\"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-1024x720.jpg\" class=\"attachment-large size-large wp-image-6843\" alt=\"\" srcset=\"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-1024x720.jpg 1024w, https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-300x211.jpg 300w, https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-768x540.jpg 768w, https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-480x338.jpg 480w, https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team.jpg 1280w\" sizes=\"(max-width: 940px) 100vw, 940px\" title=\"team\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-1632d99\" data-id=\"1632d99\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_font_size_mobile elementor-element-custom_line_height elementor-element-custom_font_weight elementor-element-custom_color elementor-element elementor-element-2634987 elementor-widget elementor-widget-text-editor\" data-id=\"2634987\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2><span>Patient Access &amp; Scheduling<\/span><\/h2>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element elementor-element-f81cbdc elementor-widget elementor-widget-text-editor\" data-id=\"f81cbdc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><span>Access everything you need to get started. Request an appointment, register as a new patient, submit a referral, or schedule a second opinion.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-60369f8 e-flex e-con-boxed e-con e-parent\" data-id=\"60369f8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-f04ed86 e-con-full e-flex e-con e-child\" data-id=\"f04ed86\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2aa792f form-tabs e-n-tabs-mobile elementor-widget elementor-widget-n-tabs\" data-id=\"2aa792f\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;horizontal_scroll&quot;:&quot;disable&quot;}\" data-widget_type=\"nested-tabs.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-tabs\" data-widget-number=\"44726575\" aria-label=\"Tabs. Open items with Enter or Space, close with Escape and navigate using the Arrow keys.\">\n\t\t\t<div class=\"e-n-tabs-heading\" role=\"tablist\">\n\t\t\t\t\t<button id=\"request-an-appointment\" data-tab-title-id=\"e-n-tab-title-447265751\" class=\"e-n-tab-title\" aria-selected=\"true\" data-tab-index=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"e-n-tab-content-447265751\" style=\"--n-tabs-title-order: 1;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tRequest an Appointment\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"refer-a-new-patient\" data-tab-title-id=\"e-n-tab-title-447265752\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-447265752\" style=\"--n-tabs-title-order: 2;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tRefer a New Patient\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"new-patient-registration\" data-tab-title-id=\"e-n-tab-title-447265753\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"3\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-447265753\" style=\"--n-tabs-title-order: 3;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tNew Patient Registration\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"schedule-second-opinion-visit\" data-tab-title-id=\"e-n-tab-title-447265754\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"4\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-447265754\" style=\"--n-tabs-title-order: 4;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tSchedule Second Opinion Visit\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"contact-us\" data-tab-title-id=\"e-n-tab-title-447265755\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"5\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-447265755\" style=\"--n-tabs-title-order: 5;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tContact Us\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t<div class=\"e-n-tabs-content\">\n\t\t\t\t<div id=\"e-n-tab-content-447265751\" role=\"tabpanel\" aria-labelledby=\"request-an-appointment\" data-tab-index=\"1\" style=\"--n-tabs-title-order: 1;\" class=\"e-active elementor-element elementor-element-5f67c31 e-con-full e-flex e-con e-child\" data-id=\"5f67c31\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6150844 elementor-widget elementor-widget-shortcode\" data-id=\"6150844\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7285-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7285\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/207#wpcf7-f7285-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7285\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7285-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"client-form\">\n\t<div class=\"form-row\">\n\t\t<div class=\"form-label\">\n\t\t\t<p>\"<span class=\"required\">*<\/span>\" indicates required fields\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>First Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Insurance Plan <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-insurance\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Treatment Requested <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-treatment\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecology Surgery\" \/><span class=\"wpcf7-list-item-label\">Gynecology Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Laparoscopy\" \/><span class=\"wpcf7-list-item-label\">Laparoscopy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Minimal Invasive\" \/><span class=\"wpcf7-list-item-label\">Minimal Invasive<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecologic Oncology\" \/><span class=\"wpcf7-list-item-label\">Gynecologic Oncology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Robotic Surgery\" \/><span class=\"wpcf7-list-item-label\">Robotic Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Endometriosis\" \/><span class=\"wpcf7-list-item-label\">Endometriosis<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>What are Your Prominent Symptoms? <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Is this a 2nd Opinion\/Transfer of Care <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-157\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-157\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-157\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-447265752\" role=\"tabpanel\" aria-labelledby=\"refer-a-new-patient\" data-tab-index=\"2\" style=\"--n-tabs-title-order: 2;\" class=\" elementor-element elementor-element-9a9f394 e-con-full e-flex e-con e-child\" data-id=\"9a9f394\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8e1290e elementor-widget elementor-widget-shortcode\" data-id=\"8e1290e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7501-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7501\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/207#wpcf7-f7501-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7501\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7501-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"client-form\">\n\t<div class=\"form-row\">\n\t\t<div class=\"form-label\">\n\t\t\t<p>\"<span class=\"required\">*<\/span>\" indicates required fields\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>First Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Insurance Plan <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-insurance\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Referring Provider Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-provider-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-provider-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Name of Referring Clinic\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"name-of-referring\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name-of-referring\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Referring Staff's Name\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"staff-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"staff-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Staff's Direct Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"staff-direct-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"staff-direct-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Staff's Email Address <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"staff-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"staff-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Treatment Requested <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-treatment\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecology Surgery\" \/><span class=\"wpcf7-list-item-label\">Gynecology Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Laparoscopy\" \/><span class=\"wpcf7-list-item-label\">Laparoscopy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Minimal Invasive\" \/><span class=\"wpcf7-list-item-label\">Minimal Invasive<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecologic Oncology\" \/><span class=\"wpcf7-list-item-label\">Gynecologic Oncology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Robotic Surgery\" \/><span class=\"wpcf7-list-item-label\">Robotic Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Endometriosis\" \/><span class=\"wpcf7-list-item-label\">Endometriosis<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Reason for Visit <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-visit-reason\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-visit-reason\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Is this a 2nd Opinion\/Transfer of Care <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-157\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-157\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-157\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<h3 class=\"form-subtitle\">Patient Details\n\t\t<\/h3>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient First Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-first-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Middle Initial\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"middle-initial\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"middle-initial\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient Last Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient Primary Phone\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"patient-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Date of Birth\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"patient-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-content\">\n\t\t\t<h3>Additional Documents (Optional)\n\t\t\t<\/h3>\n\t\t\t<h5>Document Upload\n\t\t\t<\/h5>\n\t\t\t<p>To streamline the referral process, please upload the following documents for the patient you are referring.\n\t\t\t<\/p>\n\t\t\t<ul>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Face Sheet \/ Insurance Card\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Last Chart Note\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Any Recent imaging or Pathology\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Any Recent Labs\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-file\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"your-file\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-447265753\" role=\"tabpanel\" aria-labelledby=\"new-patient-registration\" data-tab-index=\"3\" style=\"--n-tabs-title-order: 3;\" class=\" elementor-element elementor-element-926ff10 e-con-full e-flex e-con e-child\" data-id=\"926ff10\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0c34ac2 elementor-widget elementor-widget-shortcode\" data-id=\"0c34ac2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7523-o3\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7523\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/207#wpcf7-f7523-o3\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7523\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7523-o3\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"client-form\">\n\t<div class=\"form-row\">\n\t\t<div class=\"form-label\">\n\t\t\t<p>\"<span class=\"required\">*<\/span>\" indicates required fields\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient's Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Email <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Date of Birth <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Age <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-age\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"your-age\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Sex <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"your-sex\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"your-sex\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Current Address <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"current-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"current-address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>City <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>State <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-state\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-state\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>ZIP Code <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-zip\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"your-zip\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Home Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"home-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"home-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Cell Phone Number\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"cell-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"cell-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Employer Name & Address\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"employee-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employee-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Employer Phone Number\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"employee-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"employee-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row radio-4\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Language\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"language\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"language\" value=\"English\" \/><span class=\"wpcf7-list-item-label\">English<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"Haitian\" \/><span class=\"wpcf7-list-item-label\">Haitian<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"Spanish\" \/><span class=\"wpcf7-list-item-label\">Spanish<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"Italian\" \/><span class=\"wpcf7-list-item-label\">Italian<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"Chinese\" \/><span class=\"wpcf7-list-item-label\">Chinese<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"French\" \/><span class=\"wpcf7-list-item-label\">French<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"language\" value=\"Russian\" \/><span class=\"wpcf7-list-item-label\">Russian<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"language\" value=\"Arabic\" \/><span class=\"wpcf7-list-item-label\">Arabic<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Ethnicity\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-ethnicity\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-ethnicity\"><option value=\"---\">---<\/option><option value=\"Hispanic\">Hispanic<\/option><option value=\"Non-Hispanic\">Non-Hispanic<\/option><option value=\"Unknown\">Unknown<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Race\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-race\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-race\"><option value=\"---\">---<\/option><option value=\"White\">White<\/option><option value=\"Hispanic or Latino (of any race)\">Hispanic or Latino (of any race)<\/option><option value=\"Black or African American\">Black or African American<\/option><option value=\"Asian\">Asian<\/option><option value=\"American Indian\">American Indian<\/option><option value=\"Native Hawaiian and Other Pacific Islander\">Native Hawaiian and Other Pacific Islander<\/option><option value=\"Other races\">Other races<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Emergency Contact Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emergency-contact-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency-contact-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Relationship <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-relationship\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-relationship\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Address\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Who is your referring OB Doctor?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"referring-ob-doctor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"referring-ob-doctor\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Who is your Primary Care Doctor?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-care-doctor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-care-doctor\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-title\">\n\t\t\t<p>INSURANCE INFORMATION\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Primary Insurance <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-insurance\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Secondary Insurance\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-insurance\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient is Subscriber\/Policy Holder\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"policy-holder\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"policy-holder\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"policy-holder\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Patient is Subscriber\/Policy Holder\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"second-policy-holder\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"second-policy-holder\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"second-policy-holder\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-title\">\n\t\t\t<p>MEDICAL HISTORY\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Past Medical History\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"past-medical-history\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"past-medical-history\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Past Surgical History\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"past-surgical-history\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"past-surgical-history\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Medications\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-medications\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-medications\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Preferred Pharmacy\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-pharmacy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"preferred-pharmacy\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Pharmacy Location (City \/ Address)\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pharmacy-location\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pharmacy-location\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Allergies\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-allergies\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-allergies\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-title\">\n\t\t\t<p>- OBSTETRICAL HISTORY -\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Pregnancies\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnancies-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"pregnancies-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Living Children\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"living-children-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"living-children-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Vaginal Births\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"vaginal-births-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"vaginal-births-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>C-Sections\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"c-sections-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"c-sections-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Ectopic Pregnancies\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ectopic-pregnancies-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"ectopic-pregnancies-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Miscarriages\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"miscarriages-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"miscarriages-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Abortions\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"abortions-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"abortions-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Could you be pregnant?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"could-you-be-pregnant\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"could-you-be-pregnant\"><option value=\"-\">-<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-title\">\n\t\t\t<p>- GYNECOLOGICAL HISTORY -\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last PAP Smear\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"last-pap-smear\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-pap-smear\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>History of Abnormal PAP Smear\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pap-smear-history\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"pap-smear-history\"><option value=\"-\">-<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Mammogram\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"last-mammogram\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-mammogram\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Menstrual Period\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"last-menstrual-period\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"last-menstrual-period\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Date of First Menstrual Cycle\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"first-menstrual-cycle\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"first-menstrual-cycle\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Personal History of STD\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"history-of-std\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"history-of-std\"><option value=\"-\">-<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-447265754\" role=\"tabpanel\" aria-labelledby=\"schedule-second-opinion-visit\" data-tab-index=\"4\" style=\"--n-tabs-title-order: 4;\" class=\" elementor-element elementor-element-ac87966 e-flex e-con-boxed e-con e-child\" data-id=\"ac87966\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f7ac12a elementor-widget elementor-widget-shortcode\" data-id=\"f7ac12a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7513-o4\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7513\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/207#wpcf7-f7513-o4\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7513\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7513-o4\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"client-form\">\n\t<div class=\"form-row\">\n\t\t<div class=\"form-label\">\n\t\t\t<p>\"<span class=\"required\">*<\/span>\" indicates required fields\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>First Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Insurance Plan <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-insurance\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Treatment Requested <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-treatment\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecology Surgery\" \/><span class=\"wpcf7-list-item-label\">Gynecology Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Laparoscopy\" \/><span class=\"wpcf7-list-item-label\">Laparoscopy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Minimal Invasive\" \/><span class=\"wpcf7-list-item-label\">Minimal Invasive<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Gynecologic Oncology\" \/><span class=\"wpcf7-list-item-label\">Gynecologic Oncology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Robotic Surgery\" \/><span class=\"wpcf7-list-item-label\">Robotic Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-treatment[]\" value=\"Endometriosis\" \/><span class=\"wpcf7-list-item-label\">Endometriosis<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Preferred Date of Appointment\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-appointment\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-appointment\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item radio-row\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Preferred Time of Appointment\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"time-of-appointment\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"time-of-appointment\" value=\"Morning\" \/><span class=\"wpcf7-list-item-label\">Morning<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"time-of-appointment\" value=\"Afternoon\" \/><span class=\"wpcf7-list-item-label\">Afternoon<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"time-of-appointment\" value=\"Both\" \/><span class=\"wpcf7-list-item-label\">Both<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Diagnosis <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-diagnosis\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-diagnosis\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Date of Diagnosis\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-diagnosis\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-diagnosis\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Insurance Plan <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"insurance-plan\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insurance-plan\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Referring Physician or Clinic\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"referring-physician\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"referring-physician\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-447265755\" role=\"tabpanel\" aria-labelledby=\"contact-us\" data-tab-index=\"5\" style=\"--n-tabs-title-order: 5;\" class=\" elementor-element elementor-element-c9a7ea2 contact-us e-flex e-con-boxed e-con e-child\" data-id=\"c9a7ea2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1e2003f elementor-widget elementor-widget-shortcode\" data-id=\"1e2003f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7520-o5\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7520\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/207#wpcf7-f7520-o5\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7520\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7520-o5\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"client-form\">\n\t<div class=\"form-row\">\n\t\t<div class=\"form-label\">\n\t\t\t<p>\"<span class=\"required\">*<\/span>\" indicates required fields\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>First Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Last Name <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Phone Number <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Date of Birth <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"your-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>What Department Would You Like to Contact?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"select-9\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"select-9\"><option value=\"General Inquiries\">General Inquiries<\/option><option value=\"Financials (Prior Authorizations, Costs, Procedures, Coverage)\">Financials (Prior Authorizations, Costs, Procedures, Coverage)<\/option><option value=\"Billing (Questions About a Bill, EOB from Insurance, How to Make a Payment)\">Billing (Questions About a Bill, EOB from Insurance, How to Make a Payment)<\/option><option value=\"Ask Our Staff\">Ask Our Staff<\/option><option value=\"Access Medical Records\">Access Medical Records<\/option><option value=\"Media Inquiries \/ Partnerships\">Media Inquiries \/ Partnerships<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Email Address <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<div class=\"form-item-label\">\n\t\t\t\t<p>Message <span class=\"required\">*<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"form-item\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c8e88f2 elementor-widget elementor-widget-html\" data-id=\"c8e88f2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<script>\njQuery(window).on('load', function(){\n    if(window.location.hash != \"\"){\n        jQuery('.form-tabs .e-n-tab-title').attr('aria-selected', 'false');\n        jQuery(`.form-tabs .e-child`).removeClass('e-active');\n        \n        jQuery(`.form-tabs ${window.location.hash}`).attr('aria-selected', 'true');\n        jQuery(`.form-tabs .e-child[data-tab-index=\"${jQuery(`.form-tabs ${window.location.hash}`).attr('data-tab-index')}\"]`).addClass('e-active');\n    }\n    \n    if(jQuery(window).width() < 768){\n        jQuery('.form-tabs .e-n-tab-title').attr('aria-selected', 'false');\n        jQuery(`.form-tabs .e-child`).removeClass('e-active');\n        setTimeout(() => {\n            jQuery('.form-tabs').addClass('loaded');\n        }, 100);\n    }\n})\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-518bc43 elementor-hidden-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"518bc43\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<aside class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-eb257c8\" data-id=\"eb257c8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d6a310d elementor-widget elementor-widget-spacer\" data-id=\"d6a310d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-2823f82 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2823f82\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-4655b97\" data-id=\"4655b97\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ed7a390 elementor-widget elementor-widget-heading\" data-id=\"ed7a390\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">TREATMENTS<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_font_weight elementor-element elementor-element-696e058 elementor-widget elementor-widget-text-editor\" data-id=\"696e058\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/robotic-surgery\/\" style=\"color: #3262a1;\">Robotic Surgery<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/laparoscopy\/\" style=\"color: #3262a1;\">Laparoscopic Surgery<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/uterine-fibroids\/\" style=\"color: #3262a1;\">Uterine Fibroids<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/pelvic-organ-prolapse\/\" style=\"color: #3262a1;\">Pelvic Organ Prolapse<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/gynecologic-oncology\/\" style=\"color: #3262a1;\">Gynecologic Oncology<\/a><\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-5e3405b elementor-widget elementor-widget-spacer\" data-id=\"5e3405b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/aside>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-dd2417b\" data-id=\"dd2417b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ed5d46d elementor-widget elementor-widget-spacer\" data-id=\"ed5d46d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-aae3bb3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"aae3bb3\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-5a695e3\" data-id=\"5a695e3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e51d3b elementor-widget elementor-widget-heading\" data-id=\"2e51d3b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">SURGERY<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_font_weight elementor-element elementor-element-ddbfa75 elementor-widget elementor-widget-text-editor\" data-id=\"ddbfa75\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/endometriosis-2\/\" style=\"color: #3262a1;\">Endometriosis Overview<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/what-is-endometriosis\/\" style=\"color: #3262a1;\">What Is Endometriosis<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/stage-1-endometriosis\/\" style=\"color: #3262a1;\">Stages of Endometriosis<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/departments\/all-endometriosis-cases-that-we-treat\/\" style=\"color: #3262a1;\">Endometriosis Cases We Treat<\/a><\/span><\/li><li><a href=\"https:\/\/nygse.com\/index.php\/success-stories\/\"><span style=\"color: #3262a1;\">Success Stories<\/span><\/a><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-da9e2c5\" data-id=\"da9e2c5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bf0ad57 elementor-widget elementor-widget-spacer\" data-id=\"bf0ad57\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-66d9dc0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"66d9dc0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-08f2b5a\" data-id=\"08f2b5a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f665233 elementor-widget elementor-widget-heading\" data-id=\"f665233\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">RESOURCES <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_font_weight elementor-element elementor-element-7a35d90 elementor-widget elementor-widget-text-editor\" data-id=\"7a35d90\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/financing-options\/\" style=\"color: #3262a1;\">Insurance Information<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/frequently-asked-questions\/\" style=\"color: #3262a1;\">FAQs<\/a><\/span><\/li><li><a href=\"https:\/\/nygse.com\/index.php\/hospital-affiliations\/\"><span style=\"color: #3262a1;\">Hospital Affiliations<\/span><\/a><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/contact\/\" style=\"color: #3262a1;\">Contact &amp; Appointments<\/a><\/span><\/li><li><span style=\"color: #3262a1;\"><a href=\"https:\/\/nygse.com\/index.php\/news-2\/\" style=\"color: #3262a1;\">Blog \/ News<\/a><\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-af52380 e-flex e-con-boxed e-con e-parent\" data-id=\"af52380\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bfb6dad elementor-widget elementor-widget-heading\" data-id=\"bfb6dad\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Visit One of Our Locations<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8b523a8 e-flex e-con-boxed e-con e-parent\" data-id=\"8b523a8\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-40d3295 e-con-full e-flex e-con e-child\" data-id=\"40d3295\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_line_height elementor-element-custom_font_weight elementor-element-custom_color elementor-element elementor-element-129a4fb elementor-widget elementor-widget-text-editor\" data-id=\"129a4fb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><span style=\"color: #ffffff;\"><a href=\"https:\/\/share.google\/cQGgFlqXIAyIj4h3I\" target=\"_blank\" rel=\"noopener\" style=\"color: #ffffff;\">325 W. Main Street<\/a><\/span><br \/><span style=\"color: #ffffff;\"><a href=\"https:\/\/share.google\/Fj0UZJATNaXgXkxVZ\" style=\"color: #ffffff;\">Babylon, NY 11702<\/a><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e270436 e-con-full e-flex e-con e-child\" data-id=\"e270436\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element-custom_font_size elementor-element-custom_line_height elementor-element-custom_font_weight elementor-element-custom_color elementor-element elementor-element-fc60ee1 elementor-widget elementor-widget-text-editor\" data-id=\"fc60ee1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><span style=\"color: #ffffff;\"><a href=\"https:\/\/share.google\/c2scdwHQVbxPc07RT\" style=\"color: #ffffff;\" target=\"_blank\" rel=\"noopener\" data-wplink-edit=\"true\">375 E. Main Street,\u00a0<\/a><a href=\"https:\/\/share.google\/c2scdwHQVbxPc07RT\" style=\"color: #ffffff;\">Ste 7<\/a><br \/><a href=\"https:\/\/share.google\/c2scdwHQVbxPc07RT\" style=\"color: #ffffff;\">Bay Shore, NY 11706<\/a><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Access &amp; Scheduling Access everything you need to get started. Request an appointment, register as a new patient, submit a referral, or schedule a second opinion. Request an Appointment Refer a New Patient New Patient Registration Schedule Second Opinion Visit Contact Us &#8220;*&#8221; indicates required fields First Name * Last Name * Phone Number [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-207","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Contact Us | New York Gynecology Surgery<\/title>\n<meta name=\"description\" content=\"Contact New York Gynecology Surgery to make an appointment for your first time visit.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/nygse.com\/es\/contact\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Contact Us | New York Gynecology Surgery\" \/>\n<meta property=\"og:description\" content=\"Contact New York Gynecology Surgery to make an appointment for your first time visit.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nygse.com\/es\/contact\/\" \/>\n<meta property=\"og:site_name\" content=\"NYGSE\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-18T16:50:08+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1280\" \/>\n\t<meta property=\"og:image:height\" content=\"900\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/\",\"url\":\"https:\\\/\\\/nygse.com\\\/contact\\\/\",\"name\":\"Contact Us | New York Gynecology Surgery\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/nygse.com\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/team-1024x720.jpg\",\"datePublished\":\"2019-07-16T07:00:01+00:00\",\"dateModified\":\"2026-03-18T16:50:08+00:00\",\"description\":\"Contact New York Gynecology Surgery to make an appointment for your first time visit.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/#breadcrumb\"},\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/nygse.com\\\/contact\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/#primaryimage\",\"url\":\"https:\\\/\\\/nygse.com\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/team-1024x720.jpg\",\"contentUrl\":\"https:\\\/\\\/nygse.com\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/team-1024x720.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/nygse.com\\\/contact\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/nygse.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Contact\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/nygse.com\\\/#website\",\"url\":\"https:\\\/\\\/nygse.com\\\/\",\"name\":\"New York Gynecology Surgery & Endometriosis\",\"description\":\"Endometriosis &amp; Complex Pelvic Surgery\",\"publisher\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/#organization\"},\"alternateName\":\"NYGSE\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/nygse.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/nygse.com\\\/#organization\",\"name\":\"NYGSE\",\"url\":\"https:\\\/\\\/nygse.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/nygse.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/nygse.com\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/NYGSE-Logo_Horizontal_RGB.jpg\",\"contentUrl\":\"https:\\\/\\\/nygse.com\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/NYGSE-Logo_Horizontal_RGB.jpg\",\"width\":400,\"height\":147,\"caption\":\"NYGSE\"},\"image\":{\"@id\":\"https:\\\/\\\/nygse.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Contact Us | New York Gynecology Surgery","description":"Contact New York Gynecology Surgery to make an appointment for your first time visit.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/nygse.com\/es\/contact\/","og_locale":"es_MX","og_type":"article","og_title":"Contact Us | New York Gynecology Surgery","og_description":"Contact New York Gynecology Surgery to make an appointment for your first time visit.","og_url":"https:\/\/nygse.com\/es\/contact\/","og_site_name":"NYGSE","article_modified_time":"2026-03-18T16:50:08+00:00","og_image":[{"width":1280,"height":900,"url":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Tiempo de lectura":"3 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/nygse.com\/contact\/","url":"https:\/\/nygse.com\/contact\/","name":"Contact Us | New York Gynecology Surgery","isPartOf":{"@id":"https:\/\/nygse.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/nygse.com\/contact\/#primaryimage"},"image":{"@id":"https:\/\/nygse.com\/contact\/#primaryimage"},"thumbnailUrl":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-1024x720.jpg","datePublished":"2019-07-16T07:00:01+00:00","dateModified":"2026-03-18T16:50:08+00:00","description":"Contact New York Gynecology Surgery to make an appointment for your first time visit.","breadcrumb":{"@id":"https:\/\/nygse.com\/contact\/#breadcrumb"},"inLanguage":"es","potentialAction":[{"@type":"ReadAction","target":["https:\/\/nygse.com\/contact\/"]}]},{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/nygse.com\/contact\/#primaryimage","url":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-1024x720.jpg","contentUrl":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/team-1024x720.jpg"},{"@type":"BreadcrumbList","@id":"https:\/\/nygse.com\/contact\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/nygse.com\/"},{"@type":"ListItem","position":2,"name":"Contact"}]},{"@type":"WebSite","@id":"https:\/\/nygse.com\/#website","url":"https:\/\/nygse.com\/","name":"Cirug\u00eda Ginecol\u00f3gica y Endometriosis de Nueva York","description":"Endometriosis y Cirug\u00eda P\u00e9lvica Compleja","publisher":{"@id":"https:\/\/nygse.com\/#organization"},"alternateName":"NYGSE","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/nygse.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"es"},{"@type":"Organization","@id":"https:\/\/nygse.com\/#organization","name":"NYGSE","url":"https:\/\/nygse.com\/","logo":{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/nygse.com\/#\/schema\/logo\/image\/","url":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/NYGSE-Logo_Horizontal_RGB.jpg","contentUrl":"https:\/\/nygse.com\/wp-content\/uploads\/2025\/10\/NYGSE-Logo_Horizontal_RGB.jpg","width":400,"height":147,"caption":"NYGSE"},"image":{"@id":"https:\/\/nygse.com\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/pages\/207","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/comments?post=207"}],"version-history":[{"count":5,"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/pages\/207\/revisions"}],"predecessor-version":[{"id":9942,"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/pages\/207\/revisions\/9942"}],"wp:attachment":[{"href":"https:\/\/nygse.com\/es\/wp-json\/wp\/v2\/media?parent=207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}