I. PATIENT INFORMATION
- Title: (select one)
- [X] Mr.
- [] Mrs.
- [] Ms.
- [] Other
Florian
Middle Name:
Last Name:
Boudier
Gender: (select one)- [X] Male
- [] Female
18/05/2007
Address:
300 Spanish Avenue - Floor 3, Room 7
II. CONTACT INFORMATION
- Phone Number:
27585771
Email:
(( Kello ))
(( Discord: ))
kellutu
Additional Info:
Appointment being made by Dr. Alessia Amato, Medical Director for the Department of Health and Welfare. Please CC me on any information sent to the patient, as I will be joining him during this visit. I can be reached at phone number 9891 or by email at [email protected] ((can email me at PHMC Forums or LSGOV Forums. Discord is swifty1989))
III. APPOINTMENT DETAILS
- Has the patient been seen at Pillbox Hill Medical Center in the past?
- [] Yes
- [X] No
- [] Yes
- [X] No
Reason for Appointment:
Would like to schedule a physical.
Department:- [X] Medical
- [] Dental
- [] Mental Health
- [] 07/MAR/2024 - 16:00-20:00
[] 08/MAR/2024 - 16:00-20:00
[] 11/MAR/2024 - 16:00-20:00
[] 11/MAR/2024 - 16:00-20:00
Any available.