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Texas Orthopedic & Spine Associates PATIENT INFORMATION Date: / / Last Name: First Name: Middle: Address: City/State/Zip: DOB: Age: Sex: Male Female (Check One) SSN Marital Status: Married Single
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In the designated section, describe your current symptoms or concerns in detail. Be specific about the location, intensity, and duration of any pain or discomfort you are experiencing. This will allow the orthopedic specialist to assess your situation accurately.
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