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Annual Exam Form
Fill out this form before coming in for your annual exam.

Past Medical History
Send us your past medical history.

Review of Systems
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Diabetes Assessment
If you have recently been diagnosed with diabetes, please fill out this form.

Blood Glucose
Send us your blood glucose readings.

Blood Pressure
Send us your blood pressure readings.

Asthma Control Test
How well is your asthma being managed with your current medication(s)?

Prueba Para el Control del Asma
¿Qué tan bien está su asma en tratamiento?

Preferred Method of Contact
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