In-Office Medical Appointment with Richard Shames MD

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 9am-5pm (PST) to schedule a Wednesday/Thursday in–person office appointment in San Rafael, or Tuesday in Cotati with Dr. Shames. 

NO MEDICARE BILLING OR REIMBURSEMENT IS POSSIBLE.

Consent to In-Person Medical Office Visit with Dr. Richard Shames. Fill out now and send

New Patient Welcome Letter--For your information

Health Profile - after scheduling your appointment, download, fill out this form, and bring it with you to your initial appointment.

New Patient Registration Form - after scheduling your appointment, download, fill out this form, and bring it with you to your initial appointment.

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.

Dr. Richard Shames is a Harvard and University of Pennsylvania educated practicing MD who specializes in optimal hormone balancing, especially individualized thyroid care.