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Patient ID # Today's Date We strive to make each of your child's visits pleasant and comfortable, Please fill out this form completely in ink, r Your Child's Name Nickname Sex Age Birthdate SS#/SIN
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Today's date is October 28th, 2021.
Parents or legal guardians of the child are required to fill out the information.
You can fill out the required information online or by filling out a physical form and submitting it to the appropriate authorities.
The purpose is to record important information about the child for legal and administrative purposes.
Information such as the child's name, date of birth, address, and contact details may need to be reported.
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