Patient Questionnaire

Are you considering a free consultation?

Congratulations on making that first step! In preparation for your consultation, download and fill out TLBC’s Patient Questionnaire. It collects medical and personal information which will help determine whether or not you are eligible for the Band. Once completed, please fax it back to 1.800.409.8169. One of our patient care representatives will get back to you to confirm your appointment.

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