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PATIENT INFORMATION FORMS Today's Date: Your Name (first, mi, last): Date of Birth: / / Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: Primary Phone (please circle one):
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Step 1: Start by locating the current day of the month on your calendar.
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Step 2: Write down the current day in numerical format, for example, if today is the 15th, write '15'.
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Step 3: Move on to the current month. Write down the name of the month in full or its numerical representation, such as 'March' or '03'.
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Step 4: Finally, write down the current year using all four digits, for example, '2021'.
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