Request an Appointment Name* First Last Email* Phone*Date of Birth* MM slash DD slash YYYY Gender Male Female Child Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reason for visit:* Physician Preference (Optional)David S. Ballestas, M.D.Natalie DeSantis, ARNP, FNP-BC, ANCCMichael Lawson, MSN, ARNP FNP-BCInsurance Preferred Appointment TypeTelemedicineIn-PersonPreferred Day of WeekMondayTuesdayWednesdayThursdayFridayNo PreferencePreferred TimeAMPMNo PreferenceHow did you hear about us?*Existing PatientFriends/FamilyHealth FairInternetNewspaper / Print MediaPhysician ReferralTV / RadioYellow PagesYour MessageCAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ Medical Pavilion Walk-In Clinic 2525 Harbor Blvd #102 Port Charlotte, FL 33952 941-629-9190 Hours Monday – Friday 8:00am – 6:00pm
