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(386) 758FOOT phone (386) 7582032 fax www.samerafootankle.comNEW PATIENT FORM Date: Gender:MALEFEMALEPatient Last Name: First: Middle: Age: Date of Birth: Primary Language: Social Security Number:
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Start by finding a pen and a piece of paper.
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The 386 758-foot phone is a specific form used for reporting certain financial or operational data, though the exact nature of the form may vary depending on the jurisdiction or agency requiring it.
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