• Emergency Contact

  • Employment

  • Referral

  • DD slash MM slash YYYY
  • Payment

  • American Express
    Discover
    MasterCard
    Visa
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
     
  • Signature, Privacy & Terms

  • Reset signature Signature locked. Reset to sign again
    I understand that all medical costs incurred by me are my responsibility; including any charges my insurance fails to pay. I also understand that I am responsible for any collection and/or legal efforts that may be necessary on my account.
  • Reset signature Signature locked. Reset to sign again
    I authorize payment of medical benefits to the physician for services provided.
  • This field is for validation purposes and should be left unchanged.

Please be advised that of March, 2023, Dr. Portnoy will be practicing exclusively in Miami, FL at 2 locations. To schedule your appointment, please call (305) 662-8316.

X

Pin It on Pinterest

Shares
Share This