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Acupuncture & Natural Health Solutions Patient Intake Form This is a confidential record of your medical history and will be kept in this office. Information contained here will not be released to any person except when
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Document Date: 2014-10-08 01:24:00

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City

Naples / /

IndustryTerm

pharmaceuticals / /

MedicalCondition

Asthma/Hayfever / Mental Disorder / pain / Pneumonia / TB / Hypertension / Cancer / Drug abuse / Miscarriage / Epilepsy/Seizures / Kidney Disease / HIV/AIDS / Severe allergies / Infection / Arthritis / Hepatitis / Food/Drug Poisoning / Stroke / Nephritis / Anemia / Heart Disease / Alcoholism / Diabetes / Natural Health Solutions Patient Intake Form Injuries / Head Injury / /

MedicalTreatment

Acupuncture / /

Person

Injury / Toni Eatros / /

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Position

Physician / Head / /

ProgrammingLanguage

FL / /

ProvinceOrState

Florida / /

SocialTag