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Contact Information: Today's Date: d / m / y y y y Date of First Visit: d / m / y y y y Full Name (as appears on Health Card): Full Name (that you go by): Date of Birth: d / m / y y y y Age: Sex:
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Start by locating the date field on the form or document where you need to provide the date.
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Write down the day of the month in numerical form. For example, if today is the 12th, write "12."
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