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PATIENT HISTORYDATE PATIENTS NAME DATE OF BIRTH HOME PHONE FAMILY DR. REFERRING DR. REASON FOR VISIT EMAIL HEIGHT WEIGHT HOW DID YOU HEAR ABOUT OUR OFFICE SURGERIES: YES or NO (if yes, please complete
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The SURGERIES:YES or NO (if yes, please complete table below) is a fillable form in MS Word extension that should be submitted to the required address in order to provide some information. It has to be completed and signed, which may be done manually in hard copy, or via a certain solution like PDFfiller. It allows to fill out any PDF or Word document directly in your browser, customize it according to your purposes and put a legally-binding electronic signature. Right after completion, you can send the SURGERIES:YES or NO (if yes, please complete table below) to the relevant individual, or multiple ones via email or fax. The blank is printable too because of PDFfiller feature and options offered for printing out adjustment. Both in electronic and physical appearance, your form should have a organized and professional appearance. Also you can save it as the template for later, there's no need to create a new file again. All that needed is to amend the ready template.

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Surgeriesyes or no if is a question about whether someone has had any surgeries or not.
Anyone who has had surgeries may be required to file surgeriesyes or no if.
You can fill out surgeriesyes or no if by checking the appropriate box indicating whether you have had surgeries or not.
The purpose of surgeriesyes or no if is to gather information about a person's surgical history.
You must report whether you have had any surgeries or not on surgeriesyes or no if.
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