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Client Health History General InformationNameBirthdateAgeSexMAddressFPostal Code May leave message? Y N Work Telephone: Home Occupation_ ___ ___Employer_ ___ ___ ___ Practitioner name and phone___

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Fill out the 'Name' section with your full name (first name and last name).

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Fill out the 'Birthdate' section with your date of birth in the format dd/mm/yyyy.

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Calculate your current age based on your birthdate and fill out the 'Age' section.

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Indicate your gender in the 'Sex' section by selecting either 'M' for male or 'F' for female.

Who needs name-------------birthdate------age-------sexm?

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Individuals filling out various forms or applications that require personal identification information such as name, birthdate, age, and gender.

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Name, birthdate, age, and gender.

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