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Health Record #: ___ Complete or place patient label here Patient Name: (Print first, last)___ Medical Arts Building 581 Davis Drive, 3rd FloorNewmarket, ON L3Y 2P6mm dd by DOB: ___/___/___Tel: 9058954521,
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Information such as medical history, current medications, allergies, and doctor's contact information must be reported on Yourhealthfile.
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