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Formulaire de Prise de RDV

Veuillez soumettre vos informations de Médécin Référent et/ou de Patient, afin que nous puissions traiter votre prise de Rendez-Vous

SUBMIT YOUR INFORMATION BELOW TO START

FORMULAIRE DE PRISE DE RENDEZ-VOUS

Prénom du patient*

Nom du patient*

Email du patient*

Téléphone du patient

Prénom du Médecin Référant

Prefer language

Sélectionnez un emplacement

Zoom Video Session

Written Advisory Report

Both (Zoom + Written Summary)

PREFFERED APPOINTMENT TIMES (Choose all that apply)

Weekdays (morning)

Weekdays (afternoon)

Weekdays (evening)

Saturday (limited availability)

Comment pouvons-nous vous aider?

Facial Cancer / Reconstruction Advisory

Mandibular / Maxillary Reconstruction Planning

Microvascular Flap Options VS more Traditional Options Advisory

Facial Aesthetics / Contouring

Facial Feminization Surgery (FFS) Planning

Post-Radiation or Osteoradionecrosis (ORN/MROJN) Concerns

Revision Surgery Advisory

Other

UPLOAD CT IMAGING (DICOM) / PHOTOS / REPORTS

Message pour le Dr Ganry

WHAT SURGERIES OR TREATEMENTS HAVE YOU HAD IN THE PAST?

HAVE YOU RECEIVED A TREATMENT PLAN FROM ANOTHER SURGEON? If yes, please describes

I understand that this service is educational and advisory only. It does not provide medical care, diagnosis, treatment, or prescriptions, and does not establish a physician-patient relationship.

Veuillez soumettre vos informations de Médécin Référent et/ou de Patient, afin que nous puissions traiter votre prise de Rendez-Vous

CONTACT FOR COLLABORATION

INQUIRE FOR ADVISORY SERVICES

SUBMIT YOUR INFORMATION BELOW TO START

FORMULAIRE DE PRISE DE RENDEZ-VOUS

Prénom du patient*

Nom du patient*

Email du patient*

Téléphone du patient

Prénom du Médecin Référant

Prefer language

Sélectionnez un emplacement

Zoom Video Session

Written Advisory Report

Both (Zoom + Written Summary)

PREFFERED APPOINTMENT TIMES (Choose all that apply)

Weekdays (morning)

Weekdays (afternoon)

Weekdays (evening)

Saturday (limited availability)

Comment pouvons-nous vous aider?

Facial Cancer / Reconstruction Advisory

Mandibular / Maxillary Reconstruction Planning

Microvascular Flap Options VS more Traditional Options Advisory

Facial Aesthetics / Contouring

Facial Feminization Surgery (FFS) Planning

Post-Radiation or Osteoradionecrosis (ORN/MROJN) Concerns

Revision Surgery Advisory

Other

UPLOAD CT IMAGING (DICOM) / PHOTOS / REPORTS

Message pour le Dr Ganry

WHAT SURGERIES OR TREATEMENTS HAVE YOU HAD IN THE PAST?

HAVE YOU RECEIVED A TREATMENT PLAN FROM ANOTHER SURGEON? If yes, please describes

I understand that this service is educational and advisory only. It does not provide medical care, diagnosis, treatment, or prescriptions, and does not establish a physician-patient relationship.

Veuillez soumettre vos informations de Médécin Référent et/ou de Patient, afin que nous puissions traiter votre prise de Rendez-Vous

Docteur Laurent Ganry

Chirurgie Reconstructrice Maxillo-Faciale, Oncologique & Esthétique
du Visage

Assistant Professeur - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

contact@drganry.com

DrGanrymaxillofacialsurgery@Northwell.edu

Notre Cabinet Chirurgical - Northwell Health

Chirurgie Faciale Oncologique, Reconstructrice & Esthétique
idéalement situé à Long Island, New York
Lake Success: (516)-336-4755

OFFICE in LONG ISLAND

Lake Success

Maxillofacial & Facial Surgery
1999 Marcus Avenue, Suite M1

NY 11042

(516)-336-4755

OFFICE in LONG ISLAND

Lake Success

Maxillofacial & Facial Surgery
1999 Marcus Avenue, Suite M1

NY 11042

(516)-336-4755

Affiliations Hospitalières Universitaires - Northwell Health
pour la chirurgie Oncologique, Reconstructrice & Esthétique Faciale,
idéalement situés à Long Island, New York (inclus NorthShore)

LONG ISLAND JEWISH MEDICAL CENTER
270-5 76th Avenue
NY 11040

COHEN CHILDREN'S MEDICAL CENTER

269-01 76th Avenue

NY 11040

www.drganry.com

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