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Dr. Erin Walker, Ph.D. Tax I.D. ×601094947 Licensed Psychologist: # 0197521 NPI: #1972855526 Client Intake Form Names: Date: Address: Phone: (c) (w) (h) Email: Referral Source: DOB: Occupation: Medication’s):

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How to fill out intake - Dr. Erin?

01

Start by gathering all the necessary personal information, including your full name, date of birth, and contact details.

02

Provide a detailed medical history, including any chronic conditions, allergies, medications you are currently taking, and previous surgeries or hospitalizations.

03

Specify any specific symptoms or concerns that you have, along with their duration and severity.

04

Mention any current or past mental health concerns, such as anxiety or depression.

05

Indicate your lifestyle habits, such as smoking, alcohol consumption, and exercise routine.

06

If applicable, include information about your family medical history, especially if there are any hereditary conditions.

07

Lastly, review the completed intake form for accuracy and make sure all sections have been filled out appropriately.

Who needs intake - Dr. Erin?

01

Patients who are seeking medical care from Dr. Erin need to complete the intake form.

02

New patients who have never visited Dr. Erin's practice before are required to fill out the intake form.

03

Existing patients who have had significant changes in their medical history or condition may also need to update their intake form.

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What is intake - dr erin?

Intake - Dr. Erin is a form that needs to be filled out by patients before their initial appointment with Dr. Erin.

Who is required to file intake - dr erin?

All patients scheduled for an appointment with Dr. Erin are required to fill out the intake form.

How to fill out intake - dr erin?

Patients can fill out the intake form either online through the clinic's website or by filling out a physical form at the clinic.

What is the purpose of intake - dr erin?

The purpose of the intake form is to gather important information about the patient's medical history, current health status, and reason for the visit.

What information must be reported on intake - dr erin?

Patients must report their personal information, medical history, current medications, allergies, and reason for the appointment on the intake form.

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