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Long Beach State 49ers Girls Softball Clinic SATURDAY, JANUARY 24, 2015 9:30 am 12:30 pm CHECKING BEGINS AT 9:15am! CLINIC REGISTRATION DUE BY: JANUARY 22, 2015, Player's Name: Address: City: Zip:
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How to fill out shblongbeachclinicregform2015 page 1
How to fill out shblongbeachclinicregform2015 page 1:
01
Start by entering your personal information in the designated fields. This includes your full name, date of birth, address, phone number, and email address. Make sure to provide accurate information.
02
Next, indicate your gender by checking the appropriate box or selecting the relevant option.
03
Provide your emergency contact details, including the name, relationship, phone number, and address of someone who can be reached in case of an emergency.
04
If applicable, indicate your insurance information. This may include the name of your insurance provider, policy number, and group number. If you do not have insurance, leave this section blank or indicate that you are uninsured.
05
Proceed to the medical history section. Answer the questions honestly and thoroughly. It is important to disclose any pre-existing conditions, allergies, or medications you are currently taking.
06
If you have seen a healthcare provider recently, provide their name, address, and phone number in the designated field.
07
Read and understand the privacy practices and consent section. If you agree to the terms, sign and date the form accordingly.
08
Finally, review the completed page 1 to ensure all information is accurate and complete. Make any necessary corrections before submitting the form.
Who needs shblongbeachclinicregform2015 page 1:
01
Individuals who are seeking medical services at SHB Long Beach Clinic are required to fill out shblongbeachclinicregform2015 page 1.
02
Patients who are new to the clinic or have not filled out this form within the past year may need to complete page 1 again.
03
This form is necessary for providing accurate and up-to-date information to healthcare providers and ensuring appropriate medical care. Therefore, anyone seeking medical attention at SHB Long Beach Clinic should complete this form.
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What is shblongbeachclinicregform2015 page 1?
Shblongbeachclinicregform2015 page 1 is the first page of the registration form for the Long Beach Clinic.
Who is required to file shblongbeachclinicregform2015 page 1?
All patients seeking treatment at the Long Beach Clinic are required to fill out shblongbeachclinicregform2015 page 1.
How to fill out shblongbeachclinicregform2015 page 1?
Patients can fill out shblongbeachclinicregform2015 page 1 by providing their personal information, medical history, and signing the necessary consent forms.
What is the purpose of shblongbeachclinicregform2015 page 1?
The purpose of shblongbeachclinicregform2015 page 1 is to collect important information about the patient prior to their visit to the clinic.
What information must be reported on shblongbeachclinicregform2015 page 1?
The information required on shblongbeachclinicregform2015 page 1 includes the patient's name, contact details, insurance information, medical history, and any current health concerns.
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