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NEW PATENT HISTORY FORM Patient Name: Date of Birth: Referring physician: Primary care physician: List any other physicians who you would like to receive an update of your records: Do you want to

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1. Identify the problem - Take some time to reflect and identify what specific problem you are facing. It could be related to work, relationships, health, or any other aspect of your life.
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6. Seek professional help if needed - If the problem is complex or beyond your expertise, consider seeking professional help. This could involve consulting a therapist, counselor, or subject-matter expert who can provide specialized guidance.
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