Doctor's Office Intake Forms

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This customer received 7 word template designs from 5 designers. They chose this word template design from JanuXart as the winning design.

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Word Template Design Brief

Hi,

I am looking to have the following form to be replicated and combined with the other files. I do not want this form merely digitized but a new form to be created but asking the same questions with our logo etc. Please add a section for allergies and medications taken. For the Sexually transmitted infections the choices are the ones listed plus Pelvic Inflammatory Disease, Syphilis, HIV, and Hepatitis.

Please use common sense. The example file provided is a print out of a digital intake form.

Industry/Entity Type

Medical


Font styles to use
Sans Serif

Look and feel

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Requirements
Should not have
  • Good format

Files
Download all files - 3.1 MB
PDF
onpatient
Monday, September 26, 2022
PDF
HUG
Monday, September 26, 2022
PDF
HUGIC
Monday, September 26, 2022
PDF
HUG Patient Assitance Fund USE
Monday, September 26, 2022
ZIP
Payments
1st place
US$120
Total
US$120

Project Deadline
05 Oct 2022 15:54:17 UTC
Language

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