[PSYCHOLOGY] AMAHLE MTHEMBU

[Sarah Baker]

I. PATIENT INFORMATION

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• Title: (select one)
  • [] Mr.
  • [] Mrs.
  • [X] Ms.
  • [] Other
  First Name:
  AMAHLE
  
  Middle Name: (optional)
  HOPE
  
  Last Name:
  MTHEMBU
  
  Gender: (select one)
  • [] Male
  • [X] Female
  Date of Birth:
  02/OCT/2000
  
  Address:
  2362 Bridge Street - Floor 1, Room 1
  
  ZIP / Postal Code:
  N/A
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [X] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  28985848
  
  Email:
  [email protected] (( Afthaire ))
  

III. APPOINTMENT DETAILS

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• Has the patient been seen at Pillbox Hill Medical Center in the past?
  • [X] Yes
  • [] No
  Does the patient have a diagnosis?
  • [X] Yes
  • [] No
  If so, please describe:
  Allergies to nuts, opioids, and dog-hair. Previously admitted for bacterial meningitis.
  (N/A if the answer to the previous question is 'No')
  
  Reason for Appointment:
  Chronic cynophobia made worse by recent experience. I understand if my separate appointment on the 21st means I can't schedule another.
  
  Is this condition or injury related to work?
  • [X] Yes
  • [] No
  Is this condition or injury related to an auto accident?
  • [] Yes
  • [X] No
  Department:
  • [] Medical
  • [X] Psychology
  Dates & Times for Appointment: (list your available dates and times in the next 7 days - use more lines if needed and mark with an 'X' your preferred one. Note that we cannot guarantee exact scheduling, but we will do our best to accommodate the patient's wishes.)
  • Currently, 6pm to 3am on all following days:
    25/JUN/2022 to 04/JUL/2022
    Preferred Doctor for Appointment: Any.

[Sade Aliz]

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Dear Amahle Mthembu

We have received and reviewed your request.

Please update your available times, and dates, so that we may work towards getting you scheduled as soon as possible.

Kind regards,

[Sade Aliz]

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Dear Ms. Amahle Mteembu,

We have received and reviewed your request. We are delighted to inform you that Doctor Juliette Lavigne, Ph.D. will reach out via email, to arrange an appointment at a time that works with your schedule.

Kind regards,