Get the free Please Complete ENTIRE Form PATIENT REGISTRATION FORM

Health History Formation Name: Date of Birth: Medical History 1) In the past 2 years, have you been hospitalized or have you been (or are presently being) treated by Yes a medical doctor or naturopath?

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5. Provide the requested information accurately and truthfully. Double-check the spellings and numbers to ensure correctness.
6. If there are sections or questions that do not apply to you, mark them as 'N/A' or leave them blank as instructed.
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