A fresh start.

نویسنده

  • A Simanowitz
چکیده

1. Please complete the Face Sheet and sign the consent for treatment/care at the bottom of the page. 2. Read and Sign the Client Rights/Grievance/Confidentiality Policy form. 3. Print your full name, Initial all lines at ‘x’s, Write in your attorney’s name and sign the Authorization to Release form. 4. Complete the Medical History/Self-Questionnaire as best as possible. If you don’t understand something, just circle it and move on. 5. Fax to: 919-914-0996 or email to: [email protected] or bring to appointment.

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عنوان ژورنال:
  • The Health service journal

دوره 100 5194  شماره 

صفحات  -

تاریخ انتشار 1990