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In-Office Medical Appointment with
Richard Shames MD
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. Shames. NO MEDICARE BILLING OR REIMBURSEMENT IS POSSIBLE.
Consent
to In-Person Medical Office Visit with Dr.
Richard Shames. Fill out now and send
New Patient Welcome Letter--For your information
Health
Profile - after scheduling your appointment, download,
fill out this form, and bring it with you to your initial
appointment.
New Patient Registration Form - after scheduling your appointment, download,
fill out this form, and bring it with you to your initial
appointment.
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. Richard Shames is
a Harvard and University of Pennsylvania educated practicing
MD who specializes in optimal hormone balancing, especially
individualized thyroid care.
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