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Print Forlorn COUNTY GENERAL HEALTH DISTRICT INSURANCE INFORMATION CONSENT FORM Client Name:(Last)Birth Date:(First)// Male FemaleAddress: (Street)(City)(State)(Zip)Primary Insurance Information Primary
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Anyone who resides in Lorain County or is seeking health-related services in Lorain County may need to fill out the Lorain County General Health form. This could include individuals seeking vaccinations, health permits, and other related services or certifications.
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