EFTA02052297.pdf

To: Jeffrey teinUeevacationagmail.comj From: Sent Thur 5/19/2016 3:54:41 PM Subject Re: More Oncoblot Paperwork and Signature Today! To clarify: do you want me to reschedule your Consultation w/Oncoblot?-you are currently scheduled for a call at 5:45pm today... On May 19, 2016, at 11:49 AM, jeffrey E. leevacation@smail.com> wrote: no time today On Thu, May 19, 2016 at 10:21 AM, wrote: I have a quick form you must fill out prior to your consultation today and I need your signature. The signature is for their PMA contract which I need signed and returned BEFORE your consultation. This allows the doctor to freely speak with you about all the alternative therapies that we offer. The $10 for your PMA contract will be added to your visit. Questions on new form are: Current Medications: Medical History: Allergies to Medication: Surgical History: Hopitalizations: Social History: Tobacco? Marijuana? Alcohol? Caffeine: Family History: Mother? Father? please note The information contained in this communication is confidential, may be attorney-client privileged, may constitute inside information, and is intended only for the use of the addressee. It is the property of JEE Unauthorized use, disclosure or copying of this EFTA_R1_00591965 EFTA02052297 communication or any part thereof is strictly prohibited and may be unlawful. If you have received this communication in error, please notify us immediately by return e-mail or by e-mail to jeevacation@gmail com and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved EFTA_R1_00591966 EFTA02052298