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Debra Jaliman, MD Skin Care Questionnaire Patient Name: ___ Date: ___ 1. Do you follow a structured skin care regimen today (Y) or (N) a. If Yes Describe your regimen:___ ___ 2. Would you best describe
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Patients who are seeking treatment from Dr. Debra Jaliman, a dermatologist, will need to fill out medical forms to provide important background information for their appointment and treatment.
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