The Breast Cancer Consultation Service
Michael D. Lagios, M.D. • (415) 789-0965

Forms

In order to expedite the review (second opinion) of your breast cancer diagnosis, three forms must be completed:

These forms are all provided in Adobe Reader format (pdf), which can be downloaded free of charge from here.

Please fill out these forms completely and fax them to (415) 435-2293.
The Breast Cancer Consultation Service • Michael D. Lagios, M.D. • P.O. Box 950, Tiburon, California, 94920
Phone (415) 789-0965 • Fax (415) 435-2293