NEW PATIENT QUESTIONNAIRE

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Current Medical conditions:
Have you noticed a change in the health of your hair, skin, or nails?
Have you taken any steroids in the last 30 days? (e.g. testosterone, prednisone, cortisone)?
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Phone : + 1 786 334 3664

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E-Mail : drivanassist@lfstm.com

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1800 Sunset Harbour Dr., Suite 1B

Miami Beach, FL 33139

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