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PATIENT HISTORY FORM Patient Name: Todays Date: Age: Date of Birth: Height: Weight: Name of Primary Care/Family Physician: CHIEF COMPLAINT: What are you seeing the doctor for today? Have you been.

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  1. Open the template in our feature-rich online editing tool by clicking on Get form.
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  3. Hit the green arrow with the inscription Next to move on from field to field.
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  5. Add the date.
  6. Check the whole document to be sure that you have not skipped anything.
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