top of page
Home: Who We Are
Doctor and Patient

Dr. Robert J. Aquino

suddenly & unexpectedly

passed away on

February 24, 2024

 

Heroes don't always wear capes,

He wore a white coat.

            Health Consult Request Form

Use this form to request a consultation regarding your health

You will receive an e-mail or phone call from our scheduling person. It will contain some basic information about next steps. We'll require some basic contact information in order to schedule an appointment for you.

MY PRACTICE MANAGEMENT AFFILIATE

logo.JPG

 

PRIVACY WARNING:  Do not e-mail this completed form unless you confirm that your e-mail is secure.  Also your e-mail goes through our e-mail service provider and although they say that it is secure, we cannot guarantee the security of your privacy.  If you are not comfortable with the e-mail system, simply leave out details such as your date of birth or other identifying information.  Please add some form of your name so we can recognize your form.  Thank you.

 

IF YOU HAVE AN MEDICAL/HEALTH EMERGENCY-

DO NOT HESITATE

 CALL 911

or your primary care provider.

​If you are seeking a prescription for Ivermectin, I require that you download the consent form below, sign it and send it to my office.

DOWNLOAD THE

IVERMECTIN INFORMED CONSENT FORM HERE >>>>>>

Then e-mail or fax it to our office.

gcmw@dr.com or 631-923-2907

InMemoriam.JPG
Home: Welcome
700 New York Ave.JPG
bottom of page