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PATIENT REGISTRATION FORM PLEASE COMPLETE AND PRINT THE FORM PRIOR TO COMING FOR YOUR APPOINTMENT.PATIENT INFORMATION First Name:M.I.:Last Name:Preferred Name:Date of Birth:Address:Legal Sex:City:Social
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To fill out the www.shimouramd.com/files/newpatientregistration2010, please follow these steps:
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a. Bringing it in person during your first visit.
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It is a new patient registration form that needs to be completed by all new patients.
All new patients are required to fill out the registration form.
Patients need to complete all required fields on the form accurately and submit it to the medical office.
The purpose of the form is to gather important information about the new patients for medical records and billing purposes.
Patients need to report their personal information, medical history, insurance details, and emergency contacts.
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