Get the free MARK AN X ON THE PICTURE WHERE YOU HAVE PAIN OR OTHER SYMPTOMS
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American Specialty Health (ASH)
P.O. Box 509001, San Diego, CA 921509001
California Only Fax: 877.427.4777 All Other States Fax: 877.304.2746INITIAL HEALTH STATUS
ChiropracticPatient Name
Address
State
Zip
Phone
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What is mark an x on?
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Any individual or entity completing a form that requires a selection to be made may be required to mark an x on.
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Mark an x on is usually used to report a specific choice, option, or selection on a form.
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