APG New Patient Intake Form

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Thank you for filling out the online patient intake form for Advanced Pediatrics Gastroenterology. This will help reduce the waiting time for your appointment. This form was created using HIPAA compliant software and all patient information submitted will be secured.

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Please make sure to fill out all required responses. After you submit the form, a PDF of your responses will be sent to Dr. Khurana's office staff. The progress bar at the bottom of the screen shows how many pages are left.

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