Dr. Kateri Porto

First & Last Name

working EMAIL address

Re-enter your EMAIL address

Your Phone number (This is for our reference. We will not telephone you.)

How can we help you? And who referred you to us?

Please indicate your preferred appointment time

Morning
Mid-Day
Afternoon
Evening

Please review our Office hours (below), and chose some dates and times that are best for you.

I understand that Dr. Porto and Dr. Ezell are NOT in network with insurance companies but will provide me with a coded receipt, called a "superbill" so that I can submit a claim to my insurance provider for potential reimbursement on my own. I also, understand that the doctors will not speak with my insurance provider on the phone.

Yes
No

I understand that Dr. Porto and Dr. Ezell work together on each patient without exception. And that I am to take responsibility for my health by complying to at least 5 weeks of diet and lifestyle modification instead of solely relying on in office treatment alone. I also understand that if I am accepted as a patient I am to discontinue care with other holistic/alternative medicine practitioners or risk discharge for noncompliance with my personalized treatment plan.

Yes
No

I understand that Dr. Porto and Dr. Ezell usually respond to messages within 24 hrs, and that if I have not received a response within 72 hrs either the doctors response was filtered into my "spam" messages or the email address I provided was incorrect. I will write the doctors again and provide a "working" email address.

Yes
No

I understand that Dr. Porto and Dr. Ezell phone numbers are ONLY for use by CURRENT patients with "time sensitive" matters, and that all questions and comments should be relayed to these doctors at patient visits or via email.

Yes
No

After clicking on the box stating "I am not a Robot", the screen will switch to one that says "Your form has been successfully submitted! Thank you!" If it does not switch right away you MUST "Click" the button that reads, "Click to Make Contact". If you do not see this please refresh your browser and fill out and resend or email us directly at kp1111ge@gmail.com