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PATIENT MUST PRINT AND BRING THE FORM IN THE OFFICE Confidential Patient Information Please Print Clearly Dr. Mr. First Name: Address: Home Phone: Date of Birth:Ms. Mrs. City: Business Phone: Employer'd

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How to fill out please print clearly dr

1. To fill out the form, follow these steps:
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3. Find a clean and well-lit area to work in.
4. Write your name at the top of the form. Make sure to write clearly and legibly.
5. Fill in all required information, such as your address, contact details, and any other necessary details.
6. Use capital letters or print in block letters to ensure clarity.
7. Take your time and double-check your entries for accuracy.
8. If you make a mistake, use a single line to strike through the incorrect entry and write the correct information next to it.
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10. If the form requires a signature, sign your name in the designated area.
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