Review My Case

After reviewing our Cost & Insurance Coverage page, kindly submit this form to have Dr. Seckin review your case. Please complete all sections. After completing the form, click on the "SEND" button at the bottom of the page.

If you have any questions, please click here for the Contact Us page.

Please note that we exclusively focus our services on the surgical treatment of endometriosis. For that very reason, we only practice in New York City, and Dr. Tamer Seckin and Dr. Karli Goldstein only operate out of Lenox Hill Hospital. The hospital accepts most insurance plans. However, they do not participate with out-of-state Medicare or Medicaid plans. Please be advised that Seckin Endometriosis Center does not participate in the following insurance plans: Medicare, Medicaid, and all Medicaid-sponsored plans.

Please note that we will work with most major insurance companies if you have out-of-network benefits.  No matter your coverage, we encourage you not to let any insurance setbacks come between you and your health and what we can do to treat your endometriosis. When you confirm your registration, please provide the new patient coordinator with your insurance information.

Thank you for entrusting us with your healthcare, and we hope to have the honor of being your doctors.

In Good Health,
Seckin Endometriosis Center

All fields with * are required.

I am interested in scheduling surgery with Dr. Seckin*

I want my case reviewed by Dr.Seckin

Date of Birth

Date you were surgically-diagnosed with endometriosis or adhesions (leave blank if not applicable)?


Number of laparoscopies (belly button incision):


Number of laparotomies (bikini incision):


Personal input section

How can we help you? *


Summary of Medical History *


Any Current Medications? *


Do you think you will need surgery?

Yes
No

Are you considering coming to see Dr. Seckin?*

Yes
Undecided
No

Approximate time you are considering coming out:


Insurance

Name of Insurance Company

This practice don't participate in Medicare, Medicaid or Community Plans.

Type of Insurance


Insurance Policy Number


Insurance Company Phone Number


Do you know if you have out of network benefits?


Please let us know what time is best for us to call you.


How did you hear about us?

Online Research
Social media (Facebook, Instagram, etc.)
Endometriosis Foundation of America
Relative or friend who was a patient
Yelp
News article
Others

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