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PHYSICAL THERAPY & SPORTS INJURY REHABILITATION PATIENT INFORMATIONPLEASE PRINT Name: Date of Birth: Age: Address: Social Security# (last 4 digits): City: State: Zip Code: Sex: M / F Home#: Cell#:
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Gather all necessary information and documents such as personal details, medical history, and previous injuries.
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Begin by filling out the general information section, including your name, date of birth, contact information, and any other required personal details.
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