New Patient Forms

If you are a new patient at any of our locations in Northeast Florida, you can save time and expedite your visit by downloading our New Patient forms prior to your first visit.

Please print out the forms, fill in the requested information and bring the completed forms to your appointment.

Thank you again for choosing Ackerman Urology, where the most important treatment is yours.

New Patient Forms
New Patient - Spanish

Carly Camera, MBA

Manager

Carly Camera joined Ackerman Cancer Center in July 2017 and played an integral role in the successful opening of Ackerman Urology in October 2019. She manages all Ackerman Urology locations, overseeing operations, supporting continued growth, and ensuring the delivery of high-quality, patient-centered care. Carly earned her MBA in Health Care Management and her MBA in Human Resource Management from Saint Leo University. Outside of work, she enjoys spending time with family and friends, time spent outdoors fishing or near the water, and watching sports.

Kali Molter, MBA

Community Relations Specialist

Kali Molter joined Ackerman Cancer Center in August 2024 and supports community outreach, marketing initiatives, and engagement efforts. She holds both a Master of Business Administration and a Bachelor of Business Administration in marketing from the University of North Florida. A Jacksonville native and Bishop Kenny alum, Kali is passionate about contributing to and strengthening the local community. She brings experience in hospitality and event management and serves on the Jacksonville Chamber’s NEXTUP JAX Professional Development and Community Engagement committees. Outside of work, Kali enjoys living at the beach, running and yoga, traveling, and is a lifelong Jacksonville Jaguars fan.

Timothy Scott, RTR, RTT, CMD

Manager, Dosimetry, Facilities, & Research

Tim Scott joined Ackerman Cancer Center in 2003 and brings nearly 40 years of experience in radiation oncology and medical dosimetry operations. He oversees medical dosimetry, facilities, special projects, and research and has played a key role in nearly every building project and major technology launch at the center. Tim is passionate about innovation and the development, construction, and commissioning of advanced treatment technologies, including proton therapy. Beyond his professional work, Tim serves as a worship pastor and is a brass musician. In his free time, he enjoys restoring classic cars and spending time on the lake.

Greg Sarkisov, BS

Director of Information Technology

Greg Sarkisov joined Ackerman Cancer Center in September 2019 and oversees all facets of information technology and information security within the organization. Greg has over twenty years of experience in information technology and security. With over six of those years in our practice, he has led initiatives to strengthen our core security and expand the use of various technologies to help aid our staff in providing effective and efficient patient care. Greg holds a Bachelor of Science degree in information systems security from ITT Technical Institute. Outside of work, he stays active in the community and is a member of the IT Council with the Jacksonville Chamber of Commerce. In his free time, Greg enjoys spending time with his family and friends.

Jennifer Zelaya, MHA

Director of Human Resources

Jenny Zelaya is the director of human resources at Ackerman Cancer Center and Ackerman Urology, where she oversees all HR functions and fosters a positive, inclusive workplace culture. She holds a master’s degree in health administration from the University of Miami and brings extensive experience in talent management, employee engagement, and regulatory compliance. Fluent in Spanish, Jennifer enjoys staying active outside of work, playing pickleball, golfing with friends and family, and spending time with her golden retriever, Lenny.

Amy Mousa, CPA

Director of Finance and Accounting

Amy Mousa joined Ackerman Cancer Center in November 2021 and serves as the director of finance and accounting. In her role, she oversees financial operations and supports the organization’s strategic and operational goals. Amy holds a Florida CPA license and earned her Bachelor of Business Administration in accounting from the University of North Florida. Outside of work, she enjoys staying active, traveling, and spending quality time with her family.

Gigi Ackerman Schwartz, MBA

Vice President, Operations

Gigi Ackerman Schwartz joined Ackerman Cancer Center in November 2020 and leads strategic planning initiatives across all departments, directs all aspects of revenue cycle management, and works to develop and maintain relationships with community partners. Gigi holds an MBA from Tulane University. A Jacksonville native, she is involved in several local charitable and civic organizations. She serves as chair of the Art in Public Places Committee for the Cultural Council of Greater Jacksonville, is a member of the National Young Leadership Cabinet, and is a trustee of the Jewish Community Alliance and Jacksonville Jewish Center. In her free time, Gigi enjoys playing mahjong, exploring new hobbies with friends, and spending time with her husband and two-year-old daughter.

Baylee Richter, BS

Community Relations Manager

Baylee Richter joined Ackerman Cancer Center in November 2024 and oversees digital campaigns, brand strategy, and community outreach and engagement. With more than eight years of experience in events and marketing, she has led initiatives that strengthen patient engagement, community awareness, and referral growth. Baylee holds a Bachelor of Science in hospitality and tourism management from Slippery Rock University of Pennsylvania. Outside of work, she stays actively involved in the community through her service on the board of the American Lung Association. She also supports the American Cancer Society’s Cowford Ball as a member of the children’s art project committee and contributes to the Jacksonville Chamber’s NEXTUP JAX program, serving on two committees. In her free time, Baylee enjoys spending time with her Australian Shepherd, Cooper, and cheering on the Pittsburgh Steelers.