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Female Consultation Questionnaire In order to schedule a consultation with the doctor, an overview of your medical history along with a copy of your medical records are requested. Dr. Houses will

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How to Fill out Patient Formsfemale Intake121614docx:

1. Start by carefully reading each section of the form to ensure you understand the information being requested.
2. Fill in the personal information section, including your full name, date of birth, address, and contact details.
3. Provide accurate and up-to-date medical history information, including any previous diagnoses, medications, allergies, or surgeries.
4. Answer all the questions regarding your current symptoms or reason for the visit as accurately and honestly as possible.
5. If applicable, provide insurance information, including your policy number, insurance company, and any relevant details.
6. Sign and date the form at the designated area to verify that the information provided is true and accurate.
7. Review your completed form for any errors or missing information before submitting it to the healthcare provider.

Who Needs Patient Formsfemale Intake121614docx:

1. Patients who are new to a medical practice or visiting for the first time.
2. Individuals who have changed their personal or medical information since their last visit.
3. Patients who want to ensure that the healthcare providers have access to their accurate and updated medical history.

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