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New Patient Questionnaire

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Healthcare Specialists:
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Health Screening:
Test
Bone Density
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Cholesterol
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Colonoscopy
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Cologuard
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Dental Exam
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Glucose
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PSA/prostate
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Eye Exam
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Mammogram
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Pap Smear
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Immunizations
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Medical History: (please check any conditions you have been diagnosed with)
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Past Surgical History:
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Family Medical History:
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Social History:
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Medication List (you can bring your own list)
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Pharmacy
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