D. Victoria Martin MD JOTFORM (Adult questionaire) new patient
source app: D. victoria martin MD website, ADULT, basic questions,: DOB:gender identity: phone: email: address: emergency contact: Age: , Family History, Relationships w/ family + friends+romantic, marital stats, kids, raised where born where,school like, how far in school, medical issues, any previous psychatrist(s) or therapist(s), hospitalized for a osych episode? meds current or have taken, allergies, genertic mood disorders,
smoke/vape?, drink/how much, recreational drugs, how much, check all tha apply i.v drug use?,
( answer N/A-little -some- often- most (yall must be answered))
( answer :yes -some- or-no (all must be answered))
( answer select the response that est fits NONE< LITTLE
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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.