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Messenger Dermatology A Division of Compass Health George P. Plates, M.D. Patient Medical History Form Apt Date: Apt. Time: Patient Name: Today's Date: Please complete all items; this will be kept

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3. Start by entering your personal information such as name, address, and contact details.
4. Provide any relevant identification numbers or codes that may be required.
5. Follow the section-wise instructions and fill in the necessary details in each section.
6. Double-check all the information entered to ensure its accuracy.
7. If applicable, provide any additional documentation or supporting materials as requested.
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9. Sign and date the form at the designated spaces.
10. If required, make a copy of the filled-out form for your records.
11. Submit the form as per the instructions provided, either by mail, in person, or electronically.
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