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Approximate speed of your car MPH. Other car MPH 8. Were you knocked unconscious Yes No If yes for how long 9. PERSONAL INJURY QUESTIONAIRE INFORMATION ABOUT YOU Name Phone Address City State Zip Age Birthdate Sex M F S/S Employer s Name Employer s Address Your Ins. Co. CHECK SYMPTOMS YOU HAVE NOTICED SINCE THE ACCIDENT HEADACHE NECK PAIN NECK STIFF SLEEPING PROBLEMS BACK PAIN NERVOUSNESS TENSION IRRITABILITY CHEST PAIN DIZZINESS HEAD IS HEAVY PINS/NEEDLES ARMS PINS/NEEDLES LEGS...
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How to fill out age birthdatesex m f
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To fill out age, simply enter your numerical age in years.
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To fill out birthdate, enter your date of birth in the format of MM/DD/YYYY.
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To specify your sex, enter 'm' for male or 'f' for female.
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What is age birthdatesex m f?
Age birthdatesex m f refers to the individual's age, birthdate, and gender (male or female).
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On age birthdatesex m f, you must report the individual's age, birthdate, and whether they are male or female.
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