EFTA00336874.pdf

From: "Doyle, Briatma" To: ' Subject: Questionnaire Date: Mon, 26 Oct 2015 13:37:23 +0000 Attachments: NEW PATIENT FORM.pdf Inline-Images: image001.png; image002.png; image003.png; image004.png; image005.png 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 at on the 2nd Floor in-between York Avenue and the East River. Thank you, BRIANNA DOYLE Surgical Coordinator Dr. Bernard A. Rawlins TEL FAX ;hhttplAwAv.hss.edmagestic uii 4sonsiemail-icon-logo.ong htt htt htt Mt EFTA00336874