Epstein Secrets

e attached a questionnaire to this email for the patient to please complete prior to his appointment and bring with him to his consultation with Or. Rawlins on October 27, 2015 at 9:15A along with any relevant radiology imaging and reports related to his spinal issue. I do need to know the following inf

many? • Pain medication the patient is taking and if he is pain management. We are located a Thank you, BRIANNA DOYLE Surgical Coordinator Dr. Bernard A. Rawlins ;2, yr yr n the 2" Floor in-between York Avenue and the East River. EFTA00336878

e attached a questionnaire to this email for the patient to please complete prior to his appointment and bring with him to his consultation with Or. Rawlins on October 27, 2015 at 9:15A along with any relevant radiology imaging and reports related to his spinal issue. I do need to know the following inf

w many? Pain medication the patient is taking and if he is pain management. We are located at Thank you, BRIANNA DOYLE Surgical Coordinator Dr. Bernard A. Rawlins TEL FAX ;hhttplAw uii Av.hss.edmagestic 4sonsiemail-icon-logo.ong htt htt htt Mt on the 2nd Floor in-between York Avenue and the East River.

ial visit. Thank you for your cooperation. Date: Patient Name: Address: Date of Birth: Home Phone: ( ) Work: ( ) How were you referred to Dr. Rawlins: K Physician K Patient/ Friend K Insurance 0 Other: Referring Physician or Referral Source: - Address: City, State: Phone: ( ) Fax:( ) Do

Bernard A. Rawlins, M.D. NEW PATIENT INFORMATION FORM Please print all information. All blanks must be filled to allow us to serve you quickly and efficiently. If yo