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Medical History Form

In order to get you scheduled at Alexander Medical, you must first request appointment.  If you completed "Request An Appointment" then continue below.

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Have you filled out this yet?

This is an Appointment request form, if you haven't filled this out yet please fill it out below to connect your medical form to this appointment request. If you filled this out already, please ignore and complete the form above.

Thank you for submitting!

You must complete the medical form to be inputed in our system

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