To schedule your office visit, simply fill out the Consent to In-Person Medical Office Visit Form below. All lines must be filled in, including witness signature AND primary physician information in order for this form to be processed.
Fax it to: 415-472-7636.
Then call 415. 472 2343 between 9 am – 5 pm (PST) to schedule an in-person office appointment with Karilee Shames at the Cotati office. Special arrangements can be made to see Karilee at the San Rafael office, especially for those also seeing Dr. Rich or Dr. Gigi that day.
NO MEDICARE BILLING OR REIMBURSEMENT IS POSSIBLE.
Consent to In-Person Healing Session with Dr. Karilee Shames
Health Profile – after scheduling your appt, download, fill out this form, and bring it with you to your initial appt.
Our forms are in Adobe Acrobat .pdf format and can be read/printed using Adobe Acrobat Reader. A free copy of Adobe Acrobat Reader can be downloaded here.