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Fax Cover Sheet

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dr rom; ['Adebave Adenelan

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PAGES (cnet): |S

Dear Dr Ademiluyi,

Please see attached medical questionnaire for completion to support with further
return to work planning for your patlent, Mr. Mark Holand.

Please return the Medical Questionnaire via fax to F: 604,520-5552 or via
password protected email to adebayo adenekan@bertebe.ca

Do not hesitate to contact me should you have any questions.

Kind regards,

Adebayo Adenekan

OCCUPATIONAL HEALTH SPECIALIST

Occupational Health and Wellness

7; 604-802-0253 | F: 604-520-5552 | E: adebayo_adenekan@bertc.be.ca