First Visit Information

Prior to your first appointment, please download the following forms. We have given you several options which make it easier for you to access and provide this information quickly to us.

• Patient Medical History & Symptom Information
• Lyme Disease Symptom Checklist

You may:

A) Email:

1. First, download the forms to your desktop.
2. Then, fill out and save the forms (using Adobe Acrobat Reader)
3. Finally, attach the saved forms to an email and send it to drraxlen@aol.com before your first appointment.

B) Bring the completed Patient History & Symptom Information form with you to your first appointment:

1. Print the forms.
2. And then, fill out by hand.

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Location

123 W. 79th Street, 1st Floor
New York, NY 10024

Office Hours

Mon. - Fri.
9am - 5pm
T. (212) 799 - 1121
F. (212) 799 - 2377

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