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Natural Horizons Wellness Center Patient Health History Form Name: Date of Birth: Address: StreetCityStateZipContacts: Daytime PhoneCellEmailIn case of emergency: Name: Contact Phone # Occupation

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How to fill out in case of emergency

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Gather the necessary information such as personal details, emergency contacts, and any medical conditions.

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Keep a copy of important documents like identification cards, medical insurance cards, and a list of medications.

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