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Patient Information Form Please Print PATIENT NAMED ATE OF FIRST VISITADDRESSCITYSTATEZIPWORK PHONE ()SEX: M F PHONE ()AGE DATE OF BIRTHDATE OF INJURYCURRENT Driver's LICENSE#(MANDATORY)DOCTOR THAT
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Huntington Beach PT Specialists is a physical therapy clinic in Huntington Beach specializing in providing rehabilitation services.
Patients who utilize the services of Huntington Beach PT Specialists are required to file their information with the clinic.
Patients can fill out the necessary information for Huntington Beach PT Specialists by completing the paperwork provided by the clinic.
The purpose of Huntington Beach PT Specialists is to provide quality physical therapy services to individuals in need of rehabilitation.
Patients must report their personal information, medical history, and insurance details on Huntington Beach PT Specialists forms.
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