1. PROFESSIONAL EMAIL
TO: Molly Montgomery[montgomery.mbc@gmail.com]
FROM: MaiNong Xiong [jxiong93.2011@gmail.com]
DATE: December 3, 2014
SUBJECT: Physical Evaluation Form
Hi Ms. Montgomery,
Thank you trusting us with your child’s healthcare .We have received a physical evaluation form
for your child. The provider has to see the child in order for him to sign-on the form. It has been
a little over a year since the provider has seen t. The form needs to be completed in order for
your son to participate in the basketball program that begins on January 3.
We have tried contacting you via telephone and left messages, but we didn’t receive any
response. I would like to schedule an appointment for your son. If you could please give us a
call at (651)528-1542, we would be happy to schedule an appointment for your child.
You will need to bring the following items to your appointment:
 Current immunization records
 Current medications
 Insurance card
 Driver’s license
It is important that you bring the listed items to your appointment so your son can enjoy the
basketball season. If you have any questions about the listed items, you can give us a call at the
phone number listed above, and we will be able to help you. We look forward to seeing you.
Thank you,
MaiNong
MaiNong Xiong
Medical Assistant
Phone: 651-528-1542
Email: jxiong93.2011@gmail.com
1711 West County Road B., Roseville, MN 55113