Patient Information Sheet - Esse Health
_____ Date of your last bone density test? _____ Date of your last eye exam? _____ Date of last wellness exam? ... Do you wear seat belts? YES NO Do you use sunscreen? YES NO . Do you feel safe at home? YES NO Do you text while driving? YES NO. Do you drink coffee/soda/tea? YES NO If yes, how many cups/cans a day? _____ Which of the following ... ................
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