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Patient Information
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First Name:
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Last Name:
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What is your primary complaint for this visit?
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Please Select Your Primary Complaint
Acid Reflux
Allergies
Arthritis
Asthma
Backache
Bowel/Digestive
Bronchitis
Cellulitis
Cold
Constipation
Cough
Croup
Diarrhea
Eye Infection
Fever
Flu
Headache/Migraine
Laryngitis
Pink Eye
Poison Ivy/Oak
Rash
Respiratory Infection
Skin Injury
Sore Throat
Tonsilitis
UTI
Yeast Infection