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PLEASE PRINT ALL INFORMATION CLEARLY:Today's Date: ___Full Name ___Date of Birth ___ ___Street Address ___City/State/Zip ___Preferred Phone _____Other Phone ___Occupation ___ Spouses Name ___Email

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Pacific Women's Obstetrics & Gynecology is a medical practice specializing in healthcare for women, specifically in the areas of obstetrics and gynecology.

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Patients who receive medical care or treatment at Pacific Women's Obstetrics & Gynecology are required to have their medical records filed.

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The purpose of Pacific Women's Obstetrics & Gynecology is to provide comprehensive and compassionate healthcare services to women, particularly in the areas of pregnancy, childbirth, and reproductive health.

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Patients need to report their personal information, medical history, current symptoms, and any medications they are taking when filling out forms at Pacific Women's Obstetrics & Gynecology.

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