Dr. Gerald A. Niedzwiecki - Board Certified Interventional Radiologist

Heart Treatments Fibroid Treatments Back Pain Cancer Treatment ABD Aneurysm Varicose Veins

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Board Certified Interventional Radiologist

 

 

 


 

When patients call us to schedule a consultation with Dr. Niedzwiecki, there are several questions we need to ask. As a matter of your convenience, we’ve listed these questions here so you may complete them ahead of time. This is optional. If you would rather speak to someone first, this information can be taken when we contact you.

Complete the questionnaire below or call:
Monday - Friday 9:30 a.m. - 5:00 p.m.
(727) 791-7300

Ask For Patient Information

*All Fields are Required

Name*
Daytime Telephone*
How did you find us?*  

*What procedure are you interested in?

Have you had an Ultrasound, MRI, or other diagnostic imaging?

No

Yes
   

Note: Any information given is strictly confidential, and will
NOT be sold or released to any third parties.
 

   

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2655 S.R. 580, Ste 202
Clearwater, FL. 33761
ph: 727-791-7300 fax: 727-723-9010