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DOROTHY K. FRAGMENT, OR×L Specializing in Myofascial Release, Craniofacial Therapy And Wellness Strategies 1 Pinnacle Place, Ste 110, Albany, NY 12203 PHONE: 5182290411 FAX: 5183467940 PATIENT INTAKE
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Begin by gathering all necessary information. You will need personal details such as your full name, date of birth, contact information, and address. Additionally, you may need specific information related to the purpose of the form, such as medical history or employment information.
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Individuals seeking to access Dorothy's services or resources may need to fill out the intake form. This may include new clients, patients, or users who are starting or updating their engagement with Dorothy.
02
People who are required to provide specific information as part of a legal or administrative process may also need to complete the intake form. This could include individuals involved in a legal case, applicants for certain programs or services, or individuals undergoing a review or evaluation process.
03
In some cases, professionals or service providers working with Dorothy may be required to fill out the intake form for their clients or patients. This allows for seamless communication and collaboration between different parties involved.
Note: The specific individuals who need to fill out the intake form may vary depending on the nature of Dorothy's services or resources and the specific requirements of the organization or entity associated with Dorothy. It's always recommended to refer to the instructions or guidelines provided by Dorothy or their authorized representatives to determine if you are the target audience for the intake form.
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