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Copyright © 2008 Palm Beach Medical Center

Palm Beach Medical Center

Dr. Jaimy H. Bensimon M.D., P.A.
Board Certified Cardiologist
1501 Presidential Way, Suite 5
West Palm Beach, Florida 33401
Tel: (561) 686-8200 Fax: (561) 478-7426

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Welcome to Palm Beach Medical Center on-line appointment request system. To request an appointment, please enter the information requested and then click on the “Submit” button at the bottom of the page. We will get back to you usually within two (2) days, with our recommendation for the best specialist for your problem, along with a proposed appointment date and time.

Please choose two appointment dates, in order of preference

First Name

Last Name

Date of Birth

Email

Day time phone

Morning

Afternoon

Either

Yes

No

Primary

Secondary

Yes

No

Yes

No

If your insurance is an HMO, who is your primary care physician?

Phone

Email

What time of day would you prefer ?

Have you ever been a patient at Palm Beach Medical Center before ?

If so, approximately when ?

In the box below please inform us for the reason for your visit and / or any additional information you wish to provide us with.

If you will be using insurance coverage for this visit, please indicate your carrier(s)

HMO?

HMO?

How would you like us to confirm you appointment ?

This is preferred and the fastest method of confirmation, be sure the phone field is filled in

Be sure that the email field is filled in