I used this form in my private practice, to have on file and be able to request labs or other information from the medical office. Also, it was a way to make sure that I am able to obtain their anthropometric measurements. 

Pros

-Simple form

-Easy to understand

-Good to obtain at intake for future needs

-Printer friendly

Cons

-May need to add specific information per state requirements

-May be too simplistic but it is a good starting point. 

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