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PATIENT NAME: DOB: DATE: HISTORY AND INTAKE FORM PAST MEDICAL HISTORY: (please circle all that apply) Asthma Hyperthyroidism (high thyroid level) Atrial fibrillation Hypothyroidism (low thyroid level)
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How to fill out patient forms - associates:
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Patient forms - associates are paperwork that needs to be filled out by patients and their associates to provide important information about their medical history, insurance information, and contact details.
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