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Michael J. Athens, Ph.D. and Associates, Ltd. 32 Main Street, Park Ridge, IL 60068HXBackground Information/Adult Please Complete So That We Know You Better and Can Provide Excellent Care Patient Name:
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The hx-background informationadult form is a document that gathers personal information about an adult individual.
Any adult individual who is asked to complete the form by an organization or institution.
The form can be filled out by providing accurate and honest answers to the questions asked.
The purpose of the form is to gather information to assess an individual's background for various purposes such as employment or volunteer work.
Personal details, contact information, educational background, employment history, criminal record (if any), and references may need to be reported.
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