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The Urology Group New Patient Health History (page 1 of 3) Name: Date of Birth: Primary Care Doctor: Referring Doctor: Today's Date: Age: Primary Care Phone #: Referring Doctor Phone #: Preferred
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Start by carefully reading the instructions provided on the form. Make sure you understand what information is required and how it should be filled out.
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Begin by providing your personal information, such as your full name, date of birth, and contact details. Make sure to write legibly and accurately to avoid any confusion.
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Next, fill in any relevant medical history information as required. This may include details about previous urological conditions, surgeries, medications, or allergies.
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Patients seeking urological services from the specific urology group need to fill out the form. This may include individuals experiencing urinary tract issues, kidney problems, prostate concerns, or any other urological conditions.
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