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Intake Request: Physician Referral (Part 1: Physician) All patients need a physician referral before appointment can be scheduled Date of Request / / FOR OFFICE USE ONLY: Date Received: Appointment
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Start by carefully reading the instructions provided on the form. Make sure you understand what information is required in section 1.
02
Begin by entering your personal details, such as your full name, date of birth, and contact information. Fill in each field accurately and double-check for any errors.
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Now let's address who needs section 1 of the form:

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Section 1 of the form is typically required from all individuals filling out the form. It is the initial section where personal information is collected to establish the individual's identity and provide important contact details.
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Employers may need section 1 of a form to verify the identity and eligibility of their employees. This is usually seen in employment-related forms such as W-4 or I-9.
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Section 1 of a form is generally necessary for any individual or entity that needs to collect specific personal and contact information from someone for legal, administrative, or identification purposes.
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Section 1 of the form contains personal information about the individual filling out the form.
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Section 1 of the form should be completed by the employee with their personal information.
The purpose of section 1 of the form is to collect basic personal information from the employee.
Information such as name, address, date of birth, and social security number must be reported on section 1 of the form.
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