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North Country Holistic Care Center PATIENT REGISTRATION FORM Patient Information Name: Address: City: State: Zip: Telephone #:Home: Cell: Email Date of Birth: Age: Sex:Social Security #: Referred
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North Country Holistic Care is a healthcare center that offers a comprehensive approach to wellness, focusing on the physical, emotional, and spiritual aspects of health.
All patients who receive services from North Country Holistic Care are required to have their information and treatment plans filed by the healthcare provider.
To fill out North Country Holistic Care forms, patients must provide their personal information, medical history, current symptoms, and treatment goals.
The purpose of North Country Holistic Care is to address the whole person and promote healing and wellness using a combination of conventional and alternative therapies.
Information such as patient demographics, medical history, current symptoms, allergies, medications, treatment plans, and progress notes must be reported on North Country Holistic Care forms.
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