To schedule your office visit, simply fill out the Consent for In-Person Medical Office Visit form and the two-page Registration Form and Health History below.  Scan, then email completed forms (with no more than 6 pages of lab results) to:  Julie@pmcmarin.com  OR if email is not possible, then Fax your completed forms (with no more than 6 pages of lab results) 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 for In-Person Medical Office Visit with Dr. Richard Shames (Please send or fax this to our office)

Two-Page New Registration Form and Health History Fill out now and email or fax to office

Two-Page Patient Welcome Letter -- For your information

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.