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Form Approved OMB No. 09350212 Exp. Date 07×31/2016 ATTACHMENT B Revisit Questionnaire This is a short questionnaire in preparation for our site visit. In the questionnaire we ask you questions about
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How to fill out pre-visit questionnaire - center:

01
Start by carefully reading the instructions provided with the questionnaire. Take note of any specific requirements or sections that need to be completed.
02
Provide accurate personal information such as your name, date of birth, and contact details. Make sure you double-check the spelling and accuracy of this information.
03
Answer all questions honestly and to the best of your knowledge. If you are unsure about any question, it is recommended to consult with a healthcare professional or ask for clarification.
04
Pay attention to any specific medical history or symptom-related questions. Provide detailed information about any known health conditions or past surgeries.
05
If there are any sections that require you to provide a list or description, make sure to be thorough and comprehensive in your response. This will help the center better understand your needs and tailor their services accordingly.
06
Take the time to review your answers before submitting the questionnaire. Ensure that nothing is missing or inaccurately filled out. Make any necessary amendments or additions.
07
Finally, submit the completed pre-visit questionnaire to the center by the specified method, such as online submission or in-person handover.

Who needs pre-visit questionnaire - center:

01
Individuals who are scheduled for a visit or appointment at a center, such as a healthcare facility, clinic, or therapy center, often need to fill out a pre-visit questionnaire.
02
This questionnaire helps the center gather important information about the individual's medical history, current symptoms, or specific requirements before their visit.
03
It is particularly important for individuals who are new patients or who have had significant changes in their health status since their last visit.
04
The pre-visit questionnaire is beneficial for both the center and the individual, as it allows the center to better prepare for the individual's needs and ensure a seamless and efficient visit.
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The pre-visit questionnaire - center is a form that needs to be completed before visiting a particular center for a specific purpose.
Anyone who intends to visit the center is required to file the pre-visit questionnaire.
The pre-visit questionnaire can be filled out online or on a physical form provided by the center.
The purpose of the pre-visit questionnaire is to gather necessary information about the visitor and their purpose of visit to the center.
The information required on the pre-visit questionnaire may include personal details, reason for visit, date and time of visit, and any special requirements.
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