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8130 N Lake Blvd PO Box 368 Kings Beach, CA 96143 PH: 5305460400 naturamedtahoe.com Confidential Pediatric Intake Form PLEASE PRINT CLEARLY AND LEGIBLY TO ASSURE ACCURACY Today's Date: Patient name:
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Please print clearly and is a form to be filled out with neat and legible handwriting.
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Any individual or entity requested to do so by the relevant authority.
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Please print clearly and should be filled out by hand using clear and readable printing.
What is the purpose of please print clearly and?
The purpose of please print clearly and is to ensure that the information provided is easily readable and understood.
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