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Confidential medical information M1 ONLINE (Rev Apr 12) PART A: ABOUT YOU Please answer the questions on this form in BLOCK CAPITAL letters using BLACK INK Title: Surname: Date of Birth: (Mr, Mrs,
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The purpose of the m1 online medical questionnaire is to gather relevant medical information from individuals in order to provide them with appropriate medical care and treatment.
The m1 online medical questionnaire may ask for information such as medical history, current health concerns, allergies, medications, and contact information.
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