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NAME: REFERRING DOCTOR: ARE YOU:AGE: DATE: MALEFEMALERIGHT HANDEDNESS HANDEDAMBIDEXTROUSCHIEF COMPLAINT: REASON FOR VISIT: LOCATION OF YOUR PAIN: HEADSHOULDERMID BACKLEGNECKARMLOW BACKKNEEHEADACHESWRIST/HARDSHIPS/BUTTOCKSANKLE/GEOHISTORY
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The new patient form-emg 8-2-07newdocx is a document used by healthcare providers to collect relevant information from new patients during their initial visit.
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