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39180 Farewell Drive Fremont, CA 94538 phone: 510.585.2535 fax: 510.474.1798 www.fremonthandtherapy.comPATIENT REGISTRATION Today's Date: / / Home Phone: Cell Phone: Patients Last Name: First: Middle
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To fill out todaysdatehomephone--cellphone, follow these steps:
02
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04
Provide the current date in the specified format, usually MM/DD/YYYY.
05
Enter your home phone number in the designated field.
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Enter your cellphone number in the designated field.
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Anyone who is filling out a form or document that requests the current date, home phone number, or cellphone number needs to provide the details in the todaysdatehomephone--cellphone format.
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What is todaysdatehomephone--cellphone?
Todaysdatehomephone--cellphone is a form field where you can input your home phone number and cell phone number.
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Anyone filling out the form that requires their home phone and cell phone numbers on record is required to file todaysdatehomephone--cellphone.
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Simply input your home phone number in the designated field and your cell phone number in the corresponding field.
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The purpose of todaysdatehomephone--cellphone is to provide contact information for individuals filling out the form.
What information must be reported on todaysdatehomephone--cellphone?
You must report your current home phone number and cell phone number on todaysdatehomephone--cellphone.
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