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NEW PATIENT QUESTIONNAIRE Name:Date of Birth:Gender:MaleFemaleWhat is the reason for your visit? What are your main concerns for this visit? Which Physician advised you to see an Endocrinologist?
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What is your first visit with?
Your first visit is with your designated supervisor.
Who is required to file your first visit with?
You are required to file your first visit with the HR department.
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What is the purpose of your first visit with?
The purpose of your first visit is to establish a relationship and discuss expectations.
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You must report your name, contact information, and reason for scheduling a visit.
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