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Get Canada The Performance Health Centre Confidential Patient Information 2014-2024

Ne E-mail address How did you hear about us? Internet Age Sandwich board Referred by Gift Certificate Flyer Other (Please specify) Would you like to receive our month newsletter about health tips and specials? Do you have Extended Health Care: Yes / No Yes No Company Name Policy # General Health Info Major complaint What aggravates this condition? How long have you had this condition? Is it: Remaining constant Getting worse Comes and goes Getting bett.

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