Request an Appointment * MANADATORY FIELDS PATIENT INFORMATION Have you ever been treated at NewYork-Presbyterian/ Weill Cornell Medical Center? No Yes If yes, date MM/DD/YYYY * Last Name * First Name Gender Male Female Date of Birth MM/DD/YYYY * Patient's Address * City * State or Province * Post Office Code * Country * Telephone Number (Include Country code and area code) Mobile Phone Number (Include Country code and area code) Fax Number (Include Country code and area code) * Email * Verify Email * Is the patient able to communicate in English? Yes No If the patient cannot communicate in English, what is the patient's primary language? make an appointment with Dr. Ash Tewari Schedule an appointment with Dr. Tewari on-line, by mail, fax or telephone. Click here. If you do not wish to make an appointment at this time but have a question about being treated by Dr. Tewari Click here. email us Our general email address is here contact us Dr. Ash Tewari, MD 525 East 68th Street New York, NY 10065 Phone: (212) 746-5638 Click here Maps and Directions Click here   INTERMEDIARY'S INFORMATION If the patient would prefer for the ART™ program to communicate with him through another individual, please complete the information below. Intermediary's Name Relationship to Patient Address City State or Province Post Office Code Country Telephone Number (Include Country code and area code) Mobile Phone Number (Include Country code and area code) Fax Number (Include Country code and area code) Email Is the intermediary able to communicate in English? Yes No If the intermediary cannot communicate in English, what is his or her primary language? DIAGNOSIS Please list details such as biopsies, PSA measurements and scans performed - as well as any test results obtained. Be sure to include specific dates. You may be asked to mail or fax the test results. Please do not send anything until we contact you and ask you to do so. Details PREFERRED CONSULTATION DATE First choice MM/DD/YYYY Second choice MM/DD/YYYY Third choice MM/DD/YYYY Comments

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