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Foothills Health and Wellness Center New/Update Patient Assessment Name: Date: Address: Phone: SS#: Date of Birth: Zip Code: Tobacco Use: Yes / No Are you a Migrant farmworker: Yes/No If You are a
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To fill out the Foothills Health and Wellness form, follow the steps below:
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Start by opening the Foothills Health and Wellness form on your computer or mobile device.
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Enter your personal information, including your name, date of birth, and contact details.
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Provide your medical history, including any existing conditions, medications, and allergies.
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Answer the questions regarding your lifestyle choices, such as smoking or alcohol consumption.
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Specify any specific health concerns or reasons for seeking health and wellness services.
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Submit the form as per the instructions provided by Foothills Health and Wellness.

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Foothills health and wellness is a healthcare facility that provides various medical services and wellness programs.
Any healthcare facility or organization that falls under the category of foothills health and wellness must file the necessary documentation.
To fill out foothills health and wellness, one must gather all the required information and accurately complete the provided forms.
The purpose of foothills health and wellness is to ensure the well-being and medical care of individuals in the community.
Foothills health and wellness typically requires information on patient demographics, medical history, treatments provided, and insurance details.
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