Appointment Request Northstar Surgical Center Appointment Request "*" indicates required fields Referring Physician*Patient Name* First Last Choose Physician*Mounir Borno, MDWalter Brogan, MDNestor Mercado, MDAlan Sharif, MDRoberto Solis, MDCharles Addington, DOCarlos Rizo-Patron, MDPatient Phone Number*Preferred Day of the Week*First AvailableMondayTuesdayWednesdayThursdayFridayPreferred Time Frame*First AvailableMorningAfternoonConsent to be contacted for scheduling. Please read and check the box below.* I understand this does not guarantee an appointment and the patient will be contacted to complete the necessary steps for an appointment.
