Elbow Patient History Form
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C ross
M edical
G roup
Orthopaedic
I nstitute
Elbow
P atients
We
a ppreciate
y ou
t aking
t ime
t o
f ill
o ut
t he
f ollowing
i nformation.
Y our
a nswers
will
h elp
u s
t o
p rovide
y ou
w ith
o ur
b est
q uality
c are.
F eel
f ree
t o
d iscuss
t he
information
w ith
y our
n urse
w hen
y ou
a re
c alled
b ack
t o
t he
e xamination
r oom.
Some
q uestions
a llow
y ou
t o
m ark
A LL
a ppropriate
a nswers,
a nd
o thers
a sk
f or
t he
ONE
b est
a nswer.
P lease
p ay
c areful
a ttention
t o
t he
i nstructions.
W e
a re
g lad
y ou
have
c hosen
u s
t o
t ake
c are
o f
y our
o rthopaedic
n eeds.
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