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Beth Hollander, Ph.D. 358 Veterans Memorial Highway, Suite 9 Cormack, NY 11725 (516) 3368149 REGISTRATION FORM PATIENTS NAME Today's Date Social Security # Birthdate Marital Status S M D W Address

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How to fill out the registration form - dr:

01

Start by providing your personal information such as your full name, date of birth, and gender.

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If required, indicate your occupation or profession in the designated field. In this case, "dr" stands for doctor, so you would enter this information if you are a doctor.

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Check for any optional fields that you may be interested in providing, such as previous related experience or certifications. If applicable, include this information as it may enhance your profile or eligibility for certain opportunities.

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The registration form helps in identifying and categorizing individuals based on their professional qualifications, allowing for tailored and targeted communications or access to appropriate resources within the specific domain of medicine.

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