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Drtiffanysanders. com Chicago Naperville Westchester Fax 708 223-0197 MEDICAL HISTORY This information will us serve better. Client s Signature or Parent/Guardian Date CONFIDENTIALITY Please be advised that Sanders Associates clinicians are mandated reporters in Illinois. Referrals This clinician recognizes that not all conditions presented by clients are appropriate for expertise. If at any time for any reason you are dissatisfied with the clinician s services please inform the clinician so...
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What is your date of birth?
I was born on January 1st, 1990.
Who is required to file your date of birth?
Individuals are required to provide their own date of birth.
How to fill out your date of birth?
Simply write down the day, month, and year of your birth in the designated space.
What is the purpose of your date of birth?
The date of birth is used to verify an individual's identity and age.
What information must be reported on your date of birth?
You must report your full date of birth including day, month, and year.
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