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Consent Form I, ___, have read and understood the Privacy and Confidentiality Policy of Women's Health & Equality Queensland (WHEN) Consent Type (Please tick):WrittenVerbalI understand personal information
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Fill in your personal information, including name, date of birth, address, and contact details.
02
Provide your insurance information, including the name of your insurance company and policy number.
03
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Anyone who is a new patient at the Sholes Center and needs to provide their personal and medical information.
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It is a new patient form in PDF format for Sholes Center.
New patients visiting Sholes Center are required to fill out this form.
The form can be filled out electronically or printed and filled out manually.
The purpose of the form is to collect important information about new patients for Sholes Center.
Information such as personal details, medical history, insurance information, and emergency contacts must be reported on the form.
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