Request an Appointment

To request an appointment using our website, please complete the form below. After you submit this information, a representative will contact you by phone within two business days. If you have a medical emergency, dial 911.

You would like to make an appointment with:

Dr. Douglas R Birns
157 East 72nd Street
New York, NY 10021
212-744-8700

Patient Information
( *Required field )

Please enter a First Name

Please enter a Last Name

Please complete Address Line 1

Please enter a City

Please enter your 10 digit phone number with no spaces or characters. (ex: 5551234567)

You must provide a valid email

Please provide a Date of Birth (ex: MM/DD/YYYY)

Preferred Contact Time* (EST)

Preferred Contact Time is required

Appointment Information
( *Required field )

Existing Patient:* Yes No

Patient Gender: M F

Please select your insurance provider from the list of plans accepted within the Mount Sinai Health System. Accepted insurance may vary by the doctor, office location and type of service.

Reason for Visit or Diagnosis