Family Internal Medicine – Dr. Nita Rastogi

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Dr. Nita Rastogi is a board-certified internal medicine physician. She is an expert in diagnosing and treating medical diseases for her patients. She is compassionate and her goal is to keep her patients healthy.

All patients (new or existing) must complete the form and submit it before the appointment with Dr. Rastogi

Name *

First

Last

Multiple Choice *

Male
Female

select one

Patient D.O.B. *

D.O.B. format mm/dd/year

Patient's Cell Phone *

Driver License # and State of License *

if none, write none

Email *

if none, write none

Patient's Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name *

Relationship *

Contact Phone # *

Name of Pharmacy *

Give location address of Patent's Pharmacy

Pharmacy Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Primary Health Insurance Company *

If none, write self insured

Name of Person insured *

If self, write self

Patient's Relationship to the person insured *

If self or no onsurance, write self

Member ID # *

If self pay write None

Group # *

If self pay write None

Insurance Company Phone #

if known

Checkbox for consent *

By signing below, I authorize the use of my health information for medical consultation. I authorize direct payment to my physician. I permit a copy of this authorization to be used in place of the original. I understand that I am responsible for my bills, coinsurance, co-pays and deductibles. I understand that it is patient's responsibility to obtain verification requested by my physician including but not limited to labs, radiology, referrals, and any other medical related services or procedures.

Signature *

Clear Signature

sign by hand

Date *

Select Date

If patient is less than 18 years of age, Name of Parent *

if patient is 18 years or older, write N/A

If patient is less than 18 years of age, Signature of parent for payment Guarantee *

if patient is 18 years or older, write N/A

Family Internal Medicine - Patient waiting room — Patient waiting room – Family Internal Medicine

She offers the following medical services to her patients:

Primary Care
Concierge Medicine
Addiction Treatment
Aesthetic Laser Treatment

Dr. Nita Rastogi has been helping her patients for over 25 years as a primary care physician. Being trained and worked as an internal medicine physician she has developed excellent skills in treating patients with problems of diabetes, hypertension, cholesterol, simple colds, and virus infections. She can help patients suffering from simple to acute medical problems. She believes in making sure that her patients practice preventive medicine. In case a patient needs the help of a specialized physician she can arrange the consult with the specialist.

Family Internal Medicine - Patient examination room — Patient examination room – Family Internal Medicine

Dr. Rastogi’s practice participates in all major health insurance plans. Dr. Rastogi realizes that many of the patients may not have any health insurance plans or may have high deductible insurance. To help these patients, Dr. Rastogi’s practice offers concierge medicine plans. Any patient can enroll in this plan. A patient enrolled in the concierge medicine plan of Dr. Rastogi can have unlimited access to Dr. Rastogi via telemedicine, and phone calls. Patients can also have a certain number of visits to the office of Dr. Rastogi for medical consultation. The details of this plan are given in the concierge medicine section.

Dr. Rastogi has been treating her patients for alcohol and opioid addiction problems for over 10 years. She has helped many patients successfully with addiction treatment. Please check the Addiction Treatment section for details.

In addition to medical treatments, Dr. Rastogi also offers aesthetic laser treatment for spider veins removal, photo-facial, and hair removal of unwanted hair of men and women. She uses the state-of-the-art Gentle Yag laser machine for laser treatment. All details are outlined in the laser treatment section.