Urinary Tract Infection (UTI) (Women)
Form No. 1
Patient's Present State & Our Availability in that State
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Texas: 9am to 10pm CST
First Name
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Last Name
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Date of birth (MM/DD/YYYY)
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Gender at birth
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Male
Female
Weight (lbs)
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Height (inches)
*
Cell Phone / Mobile Phone
*
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