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Pankaj Singhal, MD, MS, MHCM
Oncology and Robotic Surgery Specialist
(631) 533-9733
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Patient Care
Robotic Surgery
Endometriosis
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Surgical Treatment
Hysterectomy
Laparoscopic Hysterectomy
Supracervical Hysterectomy
Total Hysterectomy with Bilateral Salpingo-Oophorectomy
Radical Hysterectomy with Bilateral Salpingo-Oophorectomy
Gynecologic Oncology
Cervical Cancer
Ovarian Cancer
Ovarian Cancer – Stage 1
Uterine Cancer
Vaginal Cancer
Vulvar Cancer
Fallopian Tube Cancer
Success Stories
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All Success Stories
Meet Our Team
Contact Us
Request an Appointment
Second Opinion
Refer a New Patient
New Patient Form
Contact Us
HOME
About Us
About NYGS
Career Opportunities
Helpful Resources
Publications
Frequently Asked Questions
Patient Care
Robotic Surgery
Endometriosis
Laparoscopy
Uterine Fibroids
Pelvic Organ Prolapse
Surgical Treatment
Hysterectomy
Laparoscopic Hysterectomy
Supracervical Hysterectomy
Total Hysterectomy with Bilateral Salpingo-Oophorectomy
Radical Hysterectomy with Bilateral Salpingo-Oophorectomy
Gynecologic Oncology
Cervical Cancer
Ovarian Cancer
Ovarian Cancer – Stage 1
Uterine Cancer
Vaginal Cancer
Vulvar Cancer
Fallopian Tube Cancer
Success Stories
Submit a Google Review
All Success Stories
Meet Our Team
Contact Us
Request an Appointment
Second Opinion
Refer a New Patient
New Patient Form
Contact Us
Refer a New Patient
- Referring Provider Offices Only -
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*
" indicates required fields
Referring Provider Name
*
Name of Referring Clinic
Referring Staff's Name
Staff's Direct Number
*
Staff's Email Address
*
Treatment Requested
*
Gynecologic Surgery
Gynecology Oncology
Laparoscopy
Robotic Surgery
Minimal Invasive
Endometriosis
Other
Reason for Visit
*
Is this a 2nd Opinion/Transfer of Care
*
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No
Referring Physician or Clinic
Patient Details
Patient First Name
*
Middle Initial
Patient Last Name
*
Patient Primary Phone
Date of Birth
MM slash DD slash YYYY
Additional Documents (Optional)
Document Upload
To streamline the referral process, please upload the following documents for the patient you are referring.
Face Sheet / Insurance Card
Last Chart Note
Any Recent Imaging or Pathology
Any Recent Labs
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Max. file size: 64 MB.
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