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Get CO Avid4 Adventure Medical And Health History Form 2005-2024

NAME OF DOCTOR NAME OF DENTIST / ADDRESS OF DOCTOR DOCTOR S PHONE NUMBER ADDRESS OF DENTIST ( ) - DENTIST S PHONE NUMBER ( ) - MEDICAL HISTORY (Please check if your child has, or has had, any of the following conditions) Head injuries Seizures Epilepsy Headaches or fainting spells Hearing problems Vision problems Asthma or respiratory problems Heart trouble Hepatitis Diabetes Jaundice AIDS Hypoglycemia Abdominal pain/problems Altitude sickness Skin problems or reactions Fros.

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