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Please fully complete every section New patient health questionnaire Title Date of birth Occupation Family name Forenames Previous surname s Home address Home tel. Postcode Work tel. Mobile E-mail By giving your mobile phone number and your e-mail address you consent to us contacting you by either of these methods including SMS messaging. An overall total score of 5 or above is AUDIT-C positive. Please give name relationship address and telephone number of next of kin For patients aged 65 and...

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