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Form Submission Problem.


Subject: Form Submission Problem.

Dear Madames/ Sirs.

I recently underwent a series of dental treatments at an organization for the family in Israel – and I now need a form that I can sign to confirm that I have undergone the treatment funded by the Ministry of Health through a “rehabilitation basket”.

For unclear reasons the clinic where I was treated refuses to send me the form-and-day On Sunday, May 1, 2022, I sent the attached message to the Rehabilitation Basket Committee of the Jerusalem District.

In my telephone conversation with them from Sunday, May 1, 2022 at 11:07 in the morning, an employee of theirs named Maya confirmed that they had received my message.

In any case, I would like to know how the procedure of sending the form to me will still be possible.


assaf benyamini.


post Scriptum. 1) The e-mail address of the committee:


2) Their phone

 number: 972-2-5314874.

3) Their fax

number: 972-2-5314877.

4) Their address:

Rehabilitation Basket Committee – Jerusalem Health Bureau,

157 Jaffa Street,


ISRAEL , Zip code: 9434249.


To: Rehabilitation Basket Committee – Jerusalem Health Bureau.

Re: Letters to the Organization for the Family in Israel attached.

Dear Madames / Sirs.

After sending the attached message to the organization for the family in Israel, I received a phone call from the clinic clerk named Dennis on Sunday, May 1, 2222, at 10:34 AM, in which she asked me to go to their clinic to sign a form to end treatment funded by Sal Rehabilitation – and vehemently refused to send it to me by email – on the pretext that she does not know, so to speak, how to do it.

Of course, submitting the form is a very simple operation – a maximum of 2 minutes of work.

What to do? As part of the procedure I have to sign the form — and I can not figure out what the hell the problem is to sit down for 2 minutes at the clinic’s computer and send me the form so I can sign it.

I will note that due to my physical disability I have difficulty physically getting to the clinic — which is why I applied for this.


assaf benyamini.


Hello to the organization for the family in Israel:

Subject: Request for clarification.

Dear Madames/ Sirs.

I underwent a series of treatments in your clinic before Passover.

On Monday, April 25, 2022 at 15:17 I received on my mobile

phone 972-58-6784040 a phone call that came from your clinic, from the number 972-2-6414571.

The clinic clerk  named Yaffa initiated this phone call, asking me to “get to the clinic for a summary”.

At the same time, from Yaffa’s words it was not possible to understand if the treatments were over, or if I had to come for more treatments. I think the doctor-waiter should be asked for his answer on this matter.

Also, I could not understand Yaffa’s requirement that I must come to the clinic to sign a form because I confirm that I received the treatment, and why she claims the clinic can not send me the form by email. Sending the form via email is a very simple operation, which will take you about a minute to a minute and a half at most – so why oblige me to reach out to you physically just to sign a document?

There is a solution available, very simple that can make it both easier for you and me-to email me the form I need to sign-and then I will send it to you with all the parts I need to fill-so why not use this simple and available solution and thus make it easier for everyone? Why look for problems where there are none?

Although I am defined as mentally handicapped, I am treated in the sheltered housing of a “Avivit” hostel – but the harm I suffer from is mental – but certainly not of Mental retardation.

I am definitely responsible for my actions and also for my life — and the mental limitation I suffer from does not prevent me from filling out a great many other documents as well, from other government ministries if and when I am required to do so. Therefore, the same mental problems will certainly not prevent me from filling out a form for your clinic – there is no connection between the two.

And to sum up: I will wait for the doctor’s answer whether there are more treatments or not. If I have to sign a form of termination of treatment, please send it to me by email so that I can fill it out and send it to you – I will not physically come to the clinic just for this purpose.


assaf benyamini,

115 Costa Rica Street,

Entrance A-Apartment 4,

Kiryat Menachem,


ISRAEL, Zip code: 9662592.

My phone numbers: at




post Scriptum. 1) My ID number: 02954740.

2) My email addresses:


























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