Patients with Medicare Same day appointments available. Past medical records important for the same day appointment. Please upload your past and current medical history. Drop files here or Select files Max. file size: 8 MB. Name* First Last Email* Phone*Location- Select One -54th Ave North, St. Petersburg, FLState Road 54, New Port Richey, FLApplegate Drive, Spring Hill, FLDoctor- Select One -Dr. Kazi Hossain - All Location, Remotely.Dr. Kazi Zayn Hassan - Mental Health Only, St- Pete Location.Algery Hafi - Spring Hill, Location.Steven Ramos - New Port Richey, Location.Kazi Hassan, MDSardha Perera, MDRandolph Butts, PsDBrenda Giles, DNP, MBAComments*Consent* I agree to the privacy policy.* I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.PhoneThis field is for validation purposes and should be left unchanged. Δ
