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Patient Registration Name M/F Age: Today's Date: Address City State ZIP Birthdate//SS# Drivers LIC # Phone (cell) (work) (home) Email address I prefer to contacted by(circle one): email phone Occupation

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How to fill out name mf age todays

01

To fill out the name, start by writing your first name followed by your last name. For example, if your name is John Doe, you would write 'John Doe'.

02

To fill out the age, write the number that represents your current age in years. For example, if you are 25 years old, you would write '25'.

03

To fill out todays, write the current date using the format 'month/day/year'. For example, if today is March 1, 2022, you would write '03/01/2022'.

Who needs name mf age todays?

01

Anyone who is required to provide their personal information in a form or document needs to fill out their name, mf (gender), age, and today's date.

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