Call 203-954-0019 for an appointment

Mark Aferzon, MD
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    • Home
    • Sinus Balloon
    • Dr. Aferzon
    • Staff
    • Forms
    • Directions
Mark Aferzon, MD
  • Home
  • Sinus Balloon
  • Dr. Aferzon
  • Staff
  • Forms
  • Directions

Patient Forms

history (pdf)

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patient info (pdf)

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notice of privacy (pdf)

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patient checklist

For Your Appointment

  • Bring pertinent CT, MRI and X-Ray film(s) and report(s).   
  • Bring pertinent studies, labwork and doctor notes.
  • Bring list of Medications (include name, dose and frequency).
  • If a referral is required by your insurance plan, please contact your primary care physician prior to your appointment, so that they may fax it to our office @ 203-954-0018.
  • All copays and deductibles are due at the time of service.
  • Bring your insurance card(s) and photo.

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