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We thank you for selecting us to provide dental care for you and your family. We will do our best to keep your trust. PLEASE PRINT LEGIBLYPatient Information Patient Name: Date: LastMaleFemaleFirstMarriedSingleChildMIOtherSocial
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Fill in your personal information such as your name, date of birth, address, and contact information.
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What is health form 1?
Health form 1 is a document used to collect information about an individual's health status.
Who is required to file health form 1?
All employees are required to file health form 1.
How to fill out health form 1?
Health form 1 can be filled out by providing accurate information about one's health conditions and history.
What is the purpose of health form 1?
The purpose of health form 1 is to assess the health status of individuals and ensure workplace safety.
What information must be reported on health form 1?
Information such as medical history, current health conditions, and medication usage must be reported on health form 1.
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