EFTA02314855.pdf

From: Sent: Monday, August 13, 2012 5:39 PM To: Kristin Mainprize Cc: Waleska I. Padillo Subject: Re: appt with Dr. Rosenwaks HI Kristin, I have =ried to fax the paperwork over, but there is no answer on the fax Can I just scan and it back to =ou? On Jul 31, 2012, at 9:04 AM, Kristin =ainprize < > =rote: As requested we =ave attached the questionnaire for you to complete and send back. Upon =eview we will contact you to schedule an appointment. If you have any =uestions feel free to or call us. Thank =ou, Kris J. =ainprize Weill Greenberg Center <QUESTIONNAIRE =NEW).doc> 1 EFTA_R1_01207896 EFTA02314855