General Enquiries<\/p>\n<\/div>
(954) 607-3811<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/i><\/div><\/div>Find Us<\/p>\n<\/div>Get directions<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/i><\/div><\/div>Hablamos Espa\u00f1ol \/ Nous Parlons Fran\u00e7ais<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/iframe><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-7\"><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two fusion-border-below-title\">\n<h2 style=\"text-align: center;\">Request an Appointment<\/h2>\n<\/div>\n<div class=\"fusion-text fusion-text-5\">\n<p style=\"text-align: center;\">By filling out your details below, you are not guaranteed an appointment. A member of our staff will be in contact with you to confirm your appointment time.<\/p>\n<\/div>\n<\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/benny-esquenazi\/wp-json\/wp\/v2\/pages\/12#wpcf7-f4-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"app-form\">\n\t<div class=\"section1\">\n\t\t<div class=\"app cf7-patient third\">\n\t\t\t<p><label> New Patient? * <span class=\"wpcf7-form-control-wrap\" data-name=\"new-patient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"new-patient\"><option value=\"\">—Please choose an option—<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-first-name third\">\n\t\t\t<p><label> First Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name *\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-last-name third\">\n\t\t\t<p><label> Last Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name *\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section2\">\n\t\t<div class=\"app cf7-phone half left\">\n\t\t\t<p><label> Phone: * <span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone *\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-email half right\">\n\t\t\t<p><label> 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value=\"M\">M<\/option><option value=\"F\">F<\/option><option value=\"Prefer not to share\">Prefer not to share<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Date of Birth * <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" max=\"2026-08-19\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Select Date\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"app cf7-comment\">\n\t\t<p><label> Comments: * <span class=\"wpcf7-form-control-wrap\" data-name=\"comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Describe the reason for your appointment\" name=\"comment\"><\/textarea><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<p><span style=\"margin-top:15px, margin-bottom:15px\">\n\t\t<\/span>\n\t<\/p>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n\t<\/p>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>Δ<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"220\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" 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src=\"https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png\" alt class=\"img-responsive wp-image-1681\" srcset=\"https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-200x48.png 200w, https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-400x95.png 400w, https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-600x143.png 600w, https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-800x191.png 800w, https:\/\/www.toplinemd.com\/benny-esquenazi\/wp-content\/uploads\/sites\/110\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-1200x286.png 1200w, 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Get directions<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/i><\/div><\/div>Hablamos Espa\u00f1ol \/ Nous Parlons Fran\u00e7ais<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/iframe><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-7\"><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two fusion-border-below-title\">\n<h2 style=\"text-align: center;\">Request an Appointment<\/h2>\n<\/div>\n<div class=\"fusion-text fusion-text-5\">\n<p style=\"text-align: center;\">By filling out your details below, you are not guaranteed an appointment. 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name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"app-form\">\n\t<div class=\"section1\">\n\t\t<div class=\"app cf7-patient third\">\n\t\t\t<p><label> New Patient? * <span class=\"wpcf7-form-control-wrap\" data-name=\"new-patient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"new-patient\"><option value=\"\">—Please choose an option—<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-first-name third\">\n\t\t\t<p><label> First Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name *\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-last-name third\">\n\t\t\t<p><label> Last Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name *\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section2\">\n\t\t<div class=\"app cf7-phone half left\">\n\t\t\t<p><label> Phone: * <span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone *\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-email half right\">\n\t\t\t<p><label> 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data-name=\"select-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" min=\"2026-08-19\" aria-invalid=\"false\" placeholder=\"Select Date\" value=\"\" type=\"date\" name=\"select-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section4\">\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Insurance: * <span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Insurance\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Gender: <span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">—Please choose an option—<\/option><option value=\"M\">M<\/option><option value=\"F\">F<\/option><option value=\"Prefer not to share\">Prefer not to share<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Date of Birth * <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" max=\"2026-08-19\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Select Date\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"app cf7-comment\">\n\t\t<p><label> Comments: * <span class=\"wpcf7-form-control-wrap\" data-name=\"comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Describe the reason for your appointment\" name=\"comment\"><\/textarea><\/span> 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Hablamos Espa\u00f1ol \/ Nous Parlons Fran\u00e7ais<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/iframe><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-7\"><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two fusion-border-below-title\">\n<h2 style=\"text-align: center;\">Request an Appointment<\/h2>\n<\/div>\n<div class=\"fusion-text fusion-text-5\">\n<p style=\"text-align: center;\">By filling out your details below, you are not guaranteed an appointment. A member of our staff will be in contact with you to confirm your appointment time.<\/p>\n<\/div>\n<\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/benny-esquenazi\/wp-json\/wp\/v2\/pages\/12#wpcf7-f4-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"app-form\">\n\t<div class=\"section1\">\n\t\t<div class=\"app cf7-patient third\">\n\t\t\t<p><label> New Patient? * <span class=\"wpcf7-form-control-wrap\" data-name=\"new-patient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"new-patient\"><option value=\"\">—Please choose an option—<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-first-name third\">\n\t\t\t<p><label> First Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name *\" value=\"\" type=\"text\" name=\"first-name\" 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