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Eating Disorders Institute of New Mexico×SM) Brenda L. Wolfe PhD PC MINOR CLINICAL INTAKE QUESTIONNAIRE TO BE COMPLETED BY PATIENT PLEASE USE BLACK INK ONLY PATIENT CONTACT INFORMATION First Name
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How to fill out minor clinical intake questionnaire:

01
Start by carefully reading each question on the questionnaire. Make sure you understand what is being asked before proceeding.
02
Provide accurate and complete information for each question. Do not skip any questions unless they are marked as optional.
03
If you are unsure about how to answer a question, ask for clarification from the healthcare professional in charge or the person providing the questionnaire.
04
Be honest and transparent with your answers. The information you provide will help healthcare professionals assess your medical history and current health status.
05
Take your time to ensure that your answers are clear and easily understandable. Avoid using ambiguous or vague language.
06
Check your answers for any errors or omissions before submitting the completed questionnaire. It is important to provide accurate information for proper diagnosis and treatment.
07
Keep in mind that the purpose of the minor clinical intake questionnaire is to gather essential information about your health. By filling it out thoroughly, you are contributing to your own healthcare and ensuring that you receive appropriate medical attention.

Who needs minor clinical intake questionnaire?

01
Minors (individuals under the age of 18) who are seeking medical treatment or care.
02
Parents or legal guardians of minors who are seeking medical treatment or care on behalf of the minor.
03
Healthcare professionals or medical facilities that require comprehensive patient information to facilitate diagnosis and treatment for minors.
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The minor clinical intake questionnaire is a form used to collect basic information about a patient's medical history, current health status, and any symptoms or issues they are experiencing.
Healthcare providers, such as doctors or nurses, are required to have patients fill out the minor clinical intake questionnaire before their appointment.
Patients can fill out the minor clinical intake questionnaire by providing accurate and detailed information about their medical history, current health concerns, and any medications they are taking.
The purpose of the minor clinical intake questionnaire is to help healthcare providers gather relevant information about a patient's health in order to provide appropriate care and treatment.
The minor clinical intake questionnaire typically includes questions about medical history, current symptoms, allergies, medications, and any recent illnesses or surgeries.
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