Contact us. Interested in Becoming a Patient?Please fill out the questionnaire.While we can’t promise a spot for everyone, we thoughtfully review each application and appreciate your interest in our practice. Name * First Name Last Name Email * How did your hear about us? Referral source please. * What's your phone number? * (###) ### #### What's your date of birth? * MM DD YYYY What is your health insurance? * Are you a brand new patient for Dr . Anastasiia Neelagaru? * Are you a commercial insurance plan patient? * Are you a Medicaid insurance plan patient? * Are you a Medicare Advantage insurance plan patient? * Are you a traditional Medicare (+/- supplemental coverage) insurance plan patient? What are the names of your medications? * Please list the names only. What are your medical conditions? * Please list the names only. If you are a patient Dr. Anastasiia Neelagaru has previously seen, when was your last visit with her? * Are you willing to login to MyChart/FollowMyHealth/AthenaHealth, etc patient's portal and download PDF reports of other doctor’s studies and visits? (this is our clinic's requirement)? If not-please do not submit the form. * This is a requirement to be a patient in our clinic. As a small clinic (not affiliated with large corporations), we rely on patients keeping scheduled visits to keep the clinic viable. No-shows fees and cancelations less than 24 hrs (for any reasons) will be charged to your card. If you can not agree to this policy, please do not submit the form. * Thank you for completing the questionnaire!We will review your application and will get back to you as soon as we are able.Please keep in mind our practice will not be open until July 7th, 2025.We can not provide any medical care until then. Important: Once you are scheduled, please obtain the following records and drop them off at our office 1-2 days prior to your appointment (preferred) or bring them with you for your visit:Your last two primary care visit notesYour most recent specialist consult note (if applicable)Your most recent lab resultsYour last mammogram and/or bone density scan report (for women)Your most recent imaging reportsYour last colonoscopy report or Cologuard/FIT test resultsIt is easier to download these records from your “MyChart” portal rather than requesting your current healthcare organization to fax them to us.