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FRANCE MEDICAL AESTHETICS Patient Registration Information This form is part of your medical record and must be completed in its entirety, please PRINT. Mr. Mrs. Miss. Ms. Dr. FIRST NAME: LAST NAME:
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How to fill out lafrance medical aesformtics patient
How to fill out lafrance medical aesformtics patient
01
Begin by obtaining the Lafrance Medical AESFormtics patient form.
02
Fill out the patient's personal information, including their name, address, phone number, and date of birth.
03
Provide details about the patient's medical history, including any pre-existing conditions, allergies, or medication they are currently taking.
04
Indicate the reason for the patient visit, whether it is for a consultation, treatment, or follow-up appointment.
05
Specify any specific concerns or areas of focus for the treatment, if applicable.
06
Sign and date the form to confirm the accuracy of the provided information.
07
Submit the completed form to the Lafrance Medical AESFormtics office or healthcare provider.
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