Thieves’ Market Case Submission Form

Yes, I have a case that I think would be a great Thieves’ Market case.  I’m willing to do the work to become famous, at least at next year’s Thieves’ Market.  Please contact me.



PLEASE print carefully and legibly * = Required Field

(I cannot possibly underemphasize the importance of legible printing)



Legible (readable) Name*: ________________________________________________



Street Address: __________________________________________________________



City, State, Zip: __________________________________________________________



Legible e-Mail Address(es)*:_______________________________________________





Legible Work Phone Number* _____________________________________________



Legible Home/Cellular Phone Number ________________________________________




My patient presented initially with the following symptoms*:







The final diagnosis turned out to be*:






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Please scan and e-mail this form to davidscrase@google.com, and Dr. Scrase will contact you.