WOODSON C. MERRELL, M.D. Telephone: Fax: Checklist for New Patient Inquiries Date: 10/10/11 Taken By: Name: Age: 32 DOB: Address: Phone: SS#: Email: Referred by: Jeffrey Epstein Current Primary Physician: Chief Complaints: . Mr. E steins eaks very highly of Dr. Merrell and suggest EFTA00571873