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Type of form: Registration and history form
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250 per pack
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Size: 8 1/2″ x 11″
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Paper weight: 24 lbs.
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Binding type: Loose
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Number of parts: 1
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Personal and insurance information sections enable to set up the patient’s account with ease
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History section provides chief complaint, current and past symptoms, as well as previous podiatric treatment information
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In-depth medical history informs you of past medical problems to aid in diagnosis and treatment
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Sections are numbered for easy completion, printed both sides on 24 lbs. bond





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