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Upstate Golisano Children's Hospital
Request an Appointment/Referral

For more information about a department or a physician, please fill out the form below, or call 315 464-KIDS or 866 543-KIDS to speak to a physician representative.

Appointment requests for Ophthalmology should go directly to 315 422-4412.

(Please do not use this form to send Consult Requests or personal emails to physicians.)

Fields with * are Required

Patient Information

The person who will be seeing the physician.

    
Contact Person

The person completing this form.

Doctor/Area of Interest
Anthony J Mortelliti, MD, Otolaryngology and Communication Sciences
Additional Information

If this is a true medical emergency, do not wait for a response, call 911. Please allow 72 hours for a response to this form

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