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4800 Linton Blvd, Suite D502A, Delray Beach, Florida, 33445 Phones: 561.808.7205 Brainfixmd.com Fax 561.584.6804CHILD INTAKE FORM I. PATIENT INFORMATION Name of the Child Date of Birth Age Person
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Step 1: Start by writing the word 'FACSIMILE' at the top of the cover sheet to indicate that it is a fax document.
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Step 2: Write your name, company name, address, and contact information in the sender's section of the cover sheet.
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Step 3: In the recipient's section, write the name of the person or organization receiving the fax, along with their fax number and contact information.
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Step 4: Add a subject line to briefly describe the content of the fax.
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Step 5: If necessary, include any additional instructions or notes in the optional message area of the cover sheet.
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Step 6: Double-check all the information on the cover sheet for accuracy and completeness.
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Step 7: Attach the cover sheet to the first page of the faxed document before sending it.
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Step 8: Send the fax using a fax machine or an online fax service, following their specific instructions.
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