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8801 E Hamden Ave #110
Denver, CO 80231
P: (303) 4818079
F: (303) 8723165
www.rootsmedical.net
info×roots medical. Outpatient Intake Questionnaire
Allquestionscontainedinthequestionnairearestrictly
confidentialandwillbecomepartofyourmedicalrecord.
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01
Start by opening the roots medical intake formdocx.
02
Read the instructions provided on the first page thoroughly.
03
Fill in your personal information accurately such as your full name, date of birth, address, and contact details.
04
Provide your medical history including any previous illnesses, surgeries, or allergies.
05
Answer the questions related to your current health condition, symptoms, and any medications you are currently taking.
06
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Submit the completed roots medical intake formdocx as instructed or to the appropriate healthcare provider.
Who needs roots medical intake formdocx?
01
Anyone who is seeking medical treatment or consultation at Roots Medical Center would need to fill out the roots medical intake formdocx. This form is designed to gather important personal and medical information that helps healthcare professionals better understand the patient's health history and current condition. It assists in providing appropriate and efficient medical care.
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