[MEDICAL] Patrick LeClair

[Patrick LeClair]

I. PATIENT INFORMATION

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• Title: (select one)
  • [X] Mr.
  • [] Mrs.
  • [] Ms.
  • [] Other
  First Name:
  Patrick
  
  Middle Name: (optional)
  
  
  Last Name:
  LeClair
  
  Gender: (select one)
  • [X] Male
  • [] Female
  Date of Birth:
  28/05/1985
  
  Address:
  #807 Richman Hotel
  
  ZIP / Postal Code:
  54355
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [X] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  2112
  
  Email:
  [email protected] (( Meco ))
  

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:
  Mild Chronic Traumatic Encephalopathy
  Post-Traumatic Stress Disorder
  Insomnia (N/A if the answer to the previous question is 'No')
  
  Reason for Appointment: Please let us know why the patient needs this appointment. (i.e. symptoms or part of the body that is affected.)
  Blood tests to establish the right dosages for items in an Individual First Aid Kit.
  
  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:
  • [X] Medical
  • [] 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.)
  • [] 06/08/2022 - All Day
    [X] 09/08/2022 - All Day
    [] 11/08/2022 - 21:30
  Preferred Doctor for Appointment: (check the list of doctors here and pick one based on personal preference. Note that this is optional and if you don't choose one, one will be automatically assigned to you.)
  N/A

[Ashlynn Hettlinger]

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Dear Mr. Patrick LeClair

We apologize for the slow response. We have received and reviewed your application. Furthermore, we regret to inform you that the hours offered, on your part, don't match our schedules. However, we are offering you ours for the next seven days. Hoping that we can find the best time for the appointment, so we are waiting for your answer.

[] 12/08/2022- 04:00 p.m.
[] 13/08/2022- All day
[] 14/08/2022- All day
[] 15/08/2022- 05:00 p.m.
[] 16/08/2022- 05:00 p.m.
[] 17/08/2022- 05:00 p.m.
[] 18/08/2022- 05:00 p.m.

Kind regards,
Dr. Ashlynn Hettlinger M.D.
Medical Department
Pillbox Hill Medical Center[/list]