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Medical H Cluestionna ire Age Patient Name Date of Birth Reason for Therapy injury or Onset Date of Related? No Yes of yes, please check one: Accident Auto Work Other of other, please explain: Are

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How to fill out cluestionna ire

1. Read the questionnaire carefully to understand the information being requested.
2. Start by filling out the basic information section, such as your name, contact details, and any other required personal information.
3. Follow the instructions provided for each question or section of the questionnaire.
4. Answer each question accurately and honestly, providing all relevant information requested.
5. Use clear and concise language to complete the questionnaire.
6. If a question does not apply to you, write 'N/A' or indicate that it is not applicable.
7. If you are unsure about a question, seek clarification or ask for assistance.
8. Double-check your answers before submitting the completed questionnaire.
9. Ensure that you have filled out all the required fields.
10. If there is a specific format or order required, make sure to follow it.
11. Review the filled-out questionnaire for any errors or omissions.
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