The following pages contain a form to complete and submit to Dr. Romano' s office. In order to use
this form, please follow the instructions below:
1. Begin by saving this document to your desktop.
You should have an icon in the upper left of this window to save, or an option under the file
menu to 'save as'.
When you select to save, a dialogue box should appear. From this box, select your 'Desktop'
as your destination and enter your name as the file name -- for example, JaneSmith.pdf
2. You should now be working with your copy of the file -- the filename you selected, example:
JaneSmith.pdf should appear above this document.
3. If you have a full copy of Adobe Acrobat, you can complete this form on your computer. Proceed
to the next page of this document and begin to complete the various form fields. Click on each
field in order to begin typing in that field. You can also use the tab key to move between fields. As
you move through the document, please remember to use the 'save' button or menu option to
save your work.
4. If you only have the free version of Acrobat (the Acrobat Reader), you should print this document
and complete the form fields.
5. Once you have completed the form, print a copy to review. This is a good way to confirm you have
completed the form, and also allows you to retain a copy for your records.
6. You can now return the form to Dr. Romano's office.
If you wish to return the form via fax, print a copy and fax it to the office at 415-981-3929.
You can also print your file and bring it to the office during your visit.