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LAUREN PREDICT D.O., F.A.C.O.O.G.OMT Patient Intake Forename: Date of Birth: Today's Date: Reason for appointment: Have you had any surgeries, hospitalizations? If yes, please explain: Current Medications:
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Open the OMT Intake Form.docx using a compatible word processing software.
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Read the instructions and questions carefully.
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Start filling out the form by providing your personal information, such as your name, date of birth, and contact details.
05
Answer the questions related to your medical history, current medications, and any previous treatments or surgeries.
06
Fill in the sections that require information about your current symptoms and pain levels.
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If applicable, provide details about any accidents or injuries that might have caused your condition.
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The OMT Intake Form.docx is typically needed by individuals who are seeking osteopathic manipulation treatment (OMT).
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It is usually required by healthcare providers, such as osteopathic physicians, chiropractors, or physical therapists, who use OMT as part of their treatment approach.
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The form helps these healthcare professionals gather relevant information about a patient's medical history, symptoms, and pain levels to better understand their condition and determine the appropriate OMT treatment plan.
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The OMT intake form is a document used to collect information about individuals or entities seeking to participate in a specific program or service related to OMT.
Individuals or entities who wish to apply for services or benefits related to OMT are generally required to file the intake form.
To fill out the OMT intake form, follow the instructions provided in the document, ensuring accurate and complete information is entered in each designated field.
The purpose of the OMT intake form is to gather essential information necessary for processing applications for OMT services or programs.
The form typically requires personal identification details, contact information, and any relevant background information pertinent to the services being requested.
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