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New Patient Intake Form - aimcdfw.com
New Patient Intake Form IRVING HQ: 9901 Valley Ranch Pkwy E #1000 . Irving, TX 75063 MESQUITE: 18601 LBJ #501 . Mesquite, TX 75150 PLANO: 4090 Mapleshade Ln. . Plano, TX 75093 972.444.0660 . www.aimc-dfw.com Page 3 of 6 GENERAL SYMPTOMS: Please check all that apply.
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