In order for us to have the absolute best relationships we’d like you to know a little about us, and in turn we’d like to know a whole lot more about you and your family. Communication and trust is the basis of all the relationships we’ve built over the years. I pay homage to my Uncle Jesse, who taught me so much about this. You see, Jesse was the old time Marcus Welby type family physician. You were more likely to see him “schmoozing” in his waiting room or holding court, telling jokes at the corner deli than sitting in his private office, reviewing the latest journals. Not that he wasn’t up-to-date, he understood the importance of relationships.

We spend a considerable amount of time with one another, and with our patients, my team and I hope we convey the same homey feeling to you. Please tell us a little bit about yourself below. We do not do this as an empty gesture at friendship, but for our team to review so that until we get to know you as well as we know our more established patients (some of whom have been with us since we opened our little, one chair, very cozy office in 1976).

If you are interested, we have a sheet of our own interests available. We seek to move our relationship from acquaintance to friendship very rapidly. If you are curious about that statement, ask any one of us. We would sincerely appreciate at least a few answers below, so that we can establish a basis upon which to migrate from acquaintances, to friends. If, however, you prefer a less personal approach from us, leave this page blank.

Please don’t fill out the entire inventory. We don’t ask that much of you. Only a couple of things that might give us some ideas of interests we share. Thanks.

Steve Markus and Team

Name:

Birthday:AnniversaryYears Married

Occupation:

Name:Age:What they do

Children:

Hobbies (and how frequently you do them)

Community Service:

The Best Movie I’ve Seen Lately Is:

Next time you are at Blockbuster, if you haven’t seen (list 3), rent it .

1.

2.

3.

The type of music I like best is:

My favorite radio stations, in order of the amount I listen to them are:

1.

2.

3.

My favorite CD’s of all time are

1.

2.

3.

I currently have this or these discs in my car:

Next time you are at a CD store, if you’ve never heard ______you should listen to it (or them).

My favorite books have been:

1.

2.

3.

The best best-seller I’ve read lately was:

My favorite local restaraunts are:

1.

2.

3.

My favorite TV shows are:

1.

2.

3.

My favorite:actor/actresssports teamgolf coursesoap operatalk show

1.

2.

3.

Something that you would never know about me, is:

Thank you for your participation. We look forward to “schmoozing”.