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Available Forms

Immigration Physical - Patient Health History Questionnaire

Family Healthcare of Fairfax, P.C.

Adverse reactions may occur if certain vaccines are given with the above conditions present. <br/>A medical waiver may be used to complete immigration paperwork requirements if any of the above are present.
Please list type of surgery and year it was done
RX or over the counter, please list which medications you are taking
If yes, please list to what and reaction
* Required field