Health Consultation Intake & Consent Form

Please fill in this form and complete it as soon as you possibly can. This allows Dr. Kaufman ample time to prepare for your consultation and provide you with the best service possible.

We understand that the questions asked may require you to reflect on the past and state details that may be hard to recall, just do your best to answer honestly. No one is asking for perfection here. All fields are required so, if you truly can not answer a question simple state that in your answer.

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