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1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your first name, last name, and date of birth. Ensure accuracy for effective communication.
3. Select your gender and provide your address details. This information is crucial for establishing your identity and ensuring proper contact.
4. Indicate your preferred method of contact by checking the appropriate boxes for home phone, cell phone, or email. This helps us reach you conveniently.
5. Fill out the sections regarding your primary care physician and any registered caregiver if applicable. This ensures that we have all necessary medical contacts on file.
6. Check any relevant medical conditions and symptoms you are experiencing. This section is vital for understanding your health needs.
7. Review all entered information for accuracy before submitting the form to ensure a smooth processing experience.

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