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PATIENT INFORMATION FORM Please complete with blue or black ink only. Please complete and bring with you to your appointment. Name: Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Age:
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Anyone who is instructed or required to fill out a form or document in blue needs to do so. This requirement may come from a specific organization, institution, or legal authority. It is important to follow the instructions or guidelines provided to ensure compliance and accuracy.
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Please only use blue refers to a specific requirement or guideline indicating that blue ink or blue color should be used in certain documents or forms.
Individuals or entities specified by the guidelines that mandate the use of blue ink or blue color for filing documents are required to comply.
To fill out please only use blue, ensure that you use a pen with blue ink and follow the instructions provided in the form or document.
The purpose of please only use blue is to maintain consistency and clarity in official documents and to assist in the identification and processing of forms.
The information that must be reported includes all required fields as indicated in the form, completed using blue ink.
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