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PATIENT REGISTRATION Patients name: ___ First MI Last do you wish to be addressed? ___ If child, parents name(s): ___ male female Birthdate: ___/___/___singlemarrieddivorced/separatedwidowedminorTelephone

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Go to the website or application where the registration form is located.

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Locate the registration form and click on the 'Register' or 'Sign Up' button.

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Enter your personal information such as name, email address, password, and any other required details.

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