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Date of Visit: Dates Revised: PLEASE FILL OUT FORM PRIOR TO YOUR VISIT HEALTH HISTORY QUESTIONNAIRE All questions contained in this questionnaire are strictly confidential and will become part of

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02

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2.1

Job applicants: When applying for a job, companies often require candidates to fill out a form that collects information about their qualifications, work experience, and contact details.

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Students: Educational institutions may require students to fill out forms for various purposes, such as enrollment, course registration, or financial aid applications.

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Health facilities: Medical clinics, hospitals, or wellness centers may utilize forms to gather patient information, medical history, or insurance details for effective healthcare delivery and record-keeping.

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Government agencies: Governmental bodies may require individuals to fill out various forms for purposes like tax reporting, license applications, social security claims, or census data collection.

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