docforest hills swim club 2015 membership sheet for new members
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FOREST HILLS SWIM CLUB 2015 MEMBERSHIP SHEET FOR NEW MEMBERS Name: __________________________________ Phone #: ____________________________ Address: ________________________________ Email: ______________________________ Please check this box if you DO NOT want your email posted in the pool directory. Email will be used for communicating information and updates relating to the club. ________________________________________ Household Members Name Date of Birth Name Date of Birth You can choose to make three equal installments. Payment Schedule dates: 3/1/15 4/1/15 5/1/14 Regardless of your type of membership, dues need to be paid in full no later than MAY 20, 2015. If interested after this date, Please contact our membership director for options. New Member please complete: Referred by: Member name (Maximum of two)___________________________ _____________________________________________________________________________________________ Please return the upper portion of this sheet with your first payment Membership type Family Single Couple Retired Single Retired Couple Initiated Dues $610 $410 $545 $345 $400 Reduced Initiation $400 $400 $400 $400 $400 Sub-Total $1010 $810 $945 $745 $800 Total with sales tax $1079 $865 $1009 $796 $854 Non-Initiated Dues Total with sales tax $750 $483 $620 $415 $470 $801 $516 $662 $443 $502 An Initiated membership type means that you have paid a one – time initiation fee of $500.00 plus tax. If you pay your th membership in full by May 15 , 2015, your initiation fee is $400.00 plus sales tax. Or you can pay the non-initiated rate for 4 th consecutive years and on the 5 year you would pay the initiated rate Make Checks Payable to: Forest Hills Swim Club Please remit to: Forest Hills Swim Club P.O. Box 54440 Cincinnati, Ohio 45254
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ForestHillsMedicalServices
Office Fax:
877.389.3138
Working Hours:
Monday: 8 AM – 6 PM
Tuesday: 8 AM – 7 PM
Wednesday: 8 AM – 7 PM
Thursday: 8 AM – 7 PM
Friday: 8 AM – 6 PM
Saturday: 8 AM – 4 PM
Sunday: Closed
Payment:
cash, check, credit cards
Description:
Our practice is dedicated to the Healthcare of Women and provides complete Obstetrical and Gynecologic services. Physicians are available within our practice specializing in high risk pregnancy and childbirth, the treatment of women with cancer, and problems related to urinary incontinence.
In the Rego Park/Forest Hills, Queens area, you want a local gynecologist you can trust with your health, a doctor who keeps your best interests in mind. Dr. James Gohar at Forest Hills Medical Services is a top OB/GYN in Queens, NYC. Come in for a visit to see the difference a personal, caring gynecologist can make in your life and in your health.
When you go to a top gynecologist in Queens like Dr. Gohar, you get the best local care you can find. His practice offers every service you need to maintain your health:
From a simple pelvic exam to a hysteroscopy
From obstetrics to birth control
From STD testing to a hymenectomy
Our procedures:
Colposcopy
Dilation and Curettage (D&C)
Endometrial Biopsy
Hysteroscopy
Hymenectomy
Hysteroscopic Myomectomy / Polypectomy
Laparoscopic Myomectomy / Hysterectomy
Myosure
OB/GYN Exam
Pelvic Exam
IUD
STD Testing
Vaginal, Pelvic Sonogram
Our History:
With the goal of providing unique and personalized medical care, Forest Hills Medical Services was founded in 1986 by Dr. S. Soukkary and Dr. S. Gohar.
In 2013, Dr. James A. Gohar took over his mother’s practice with the aim of continuing her patient-centric approach to obstetrics and gynecology. Under Dr. Gohar’s leadership, the office was completely renovated to modernize the space, incorporate new technology, and make it as welcoming and comfortable for patients as possible.
Our Focus:
Our patient’s comfort and individuality are what drive us and we are proud to continue this tradition for over 30 years.
As many in the community can attest to, we take pride in having a simple and sound approach to old-fashioned medicine while using the most advanced technology available today. We offer our patients one-on-one personal care without the long lines.
The number one priority for us is always our patients, first and foremost. Call to Forest Hills Medical Services for an appointment by this number: 718.897.5331
Forest Hills Medical Services is a AAAASF Certified facility
Forest Hills Medical Services
108-16 63 Road
Forest Hills, NY 11375
718.897.5331
877.389.3138
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