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Adult History Form PATIENT NAME: 1) Have you had a hearing test before? (circle one) Yes No If yes, when and where? 2) Have you been previously diagnosed with hearing loss? Yes If yes, please indicate
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To fill out 'Have you had?' form, follow these steps:
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Begin by entering your personal information such as name, date of birth, and contact details.
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Answer the question 'Have you had?' by selecting the appropriate option.
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If you have had the specific experience or condition mentioned, choose 'Yes'. Otherwise, select 'No'.
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