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Patient Name: ___Home Phone: ___Address: ___Cell Phone: ___Date of Birth: ___Would you like text Reminders for appts? YHeight: ___ft___inchesEmail: ___Weight: ___lbsWork Phone: ___Marital Status:Employer:
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Who needs mark with an x?
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Mark with an x typically refers to a method of indicating a selection or response on a form, often used in surveys, applications, or official documents.
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To fill out mark with an x, simply place an 'X' in the designated box or area on the form next to the appropriate option or response.
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