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CU Sports Clinic Health Assessment Updated: 09/04311 Mapleton Ave. Boulder, Colorado 80304Patient LabelPlease fill out the entire form:CONFIDENTIAL MEDICAL QUESTIONNAIREPatient Name: ___DOB: ___Occupation:
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Start by downloading the new-patient-intake-formpdf from the provided source.
02
Fill out your personal information, including your full name, date of birth, address, and contact information.
03
Provide details about your medical history, including any pre-existing conditions, allergies, medications you are currently taking, and past surgeries or procedures.
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Who needs new-patient-intake-formpdf?
01
New patients who are seeking medical treatment or care from a healthcare provider.
02
Patients who have not previously filled out an intake form for the specific healthcare provider they are visiting.
03
Healthcare providers who require patients to complete intake forms before receiving treatment or care.
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What is new-patient-intake-formpdf?
New-patient-intake-formpdf is a form used for collecting information from new patients at a healthcare facility.
Who is required to file new-patient-intake-formpdf?
New patients visiting a healthcare facility are required to fill out the new-patient-intake-formpdf.
How to fill out new-patient-intake-formpdf?
New patients can fill out the new-patient-intake-formpdf by providing accurate information about their personal and medical history.
What is the purpose of new-patient-intake-formpdf?
The purpose of new-patient-intake-formpdf is to gather important information about the patient's health, medical history, and contact details.
What information must be reported on new-patient-intake-formpdf?
New-patient-intake-formpdf typically includes information such as personal details, medical history, allergies, medications, and emergency contacts.
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