EFTA00336878.pdf

From: To: merwin dela crux < Subject: Fwd: Questionnaire Date: Mon, 26 Oct 2015 14:14:59 +0000 Attachments: NEW PATIENT_FORM.pdf Inline-Images: image001.png; image002.png; image003.png; image004.png; image005.png Begin forwarded message: From: "Doyle, Brianna" < Subject: Questionnaire Date: October 26, 2015 at 9:37:23 AM EDT To: ' ' < Good morning, I have 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 information prior to the appointment: • Leg or arm pain? How long? • Injections? How 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