Appointment About the Patient Patient's name * Patient's Phone Number * Patient's Email Insurance Type * PI WC Private Insurance Medicare Other Other type of insurance Specify what type of insurance you have Insurance Information * is there an attorney involved with this appointment? * Yes No Attorney's Name * Attorney's Phone number * About the appointment Please tell us the appointment date you would like to have * Please tell us the time of appointment 8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM Select requested specialty * Orthopedic First available Medical Doctor Chiropractic Other Other Specialty * Select requested doctor (optional) G.B. Haeri, M.D. (Diplomate American Board of Orthopedic Surgery) Kyle Landauer, M.D., QME (Diplomate American Board of Orthopedic Surgery) Pablo Pazmino, M.D. (Diplomate American Board of Orthopedic Spinal Surgery) Robert Reisch, M.D. (Diplomate American Board of Orthopedic Surgery) Moris Elie, D.C., QME (Doctor of Chiropractic) Karine Jeghelian, D.C. (Doctor of Chiropractic) Nader Afshar, OMD, L.Ac. (Acupuncture) RONNA S. PARSA, D.O. Orthopedic Surgeon (Fellowship-Trained in Sports Medicine & Minimally-Invasive Arthroscopic Surgery) Special Notes, Requests or Instruction Untitled Submit If you are human, leave this field blank.