In-Office Healing Sessions with Karilee Shames PhD RN

To schedule your office visit, simply fill out the Consent to In-Person Medical Office Visit Form below. All lines must be filled in, including witness signature AND primary physician information in order for this form to be processed. Fax it to: 415-472-7636. Then call 415-472-2343 between 9am-5pm (PST) to schedule a Wednesday/Thursday in–person office appointment in San Rafael, or Tuesday in Cotati with Dr. Karilee Shames. NO MEDICARE BILLING OR REIMBURSEMENT IS POSSIBLE.

Consent to In-Person Healing Session with Dr. Karilee Shames

Health Profile - after scheduling your appt, download, fill out this form, and bring it with you to your initial appt.

Our forms are in Adobe Acrobat .pdf format and can be read/printed using Adobe Acrobat Reader. A free copy of Adobe Acrobat Reader can be downloaded here.

Dr. Karilee Shames is a Certified Clinical Specialist in Psychiatric Nursing and in Holistic Nursing. Read more about my practice.