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Available Forms

2.Adult Health History

Patient's Information

Please indicate if you suffer from any medication allergies. Also, indicate the effect, for example, "rash on neck". If you have no allergies, please indicate NO
Please list all medication that you are currently taking, including supplements, and over the counter medication.
List any surgeries you have had.
List any hospitalizations you have had.
Have you had any of the following?

Body Systems Review

Male Health

Female Health

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