Adventhealthimagingeastfl.com

Check the appropriate box

WEBTO BE COMPLETED BY THE PATIENT: What was the date of the first day of your last period? Check the appropriate box: YES NO ¨ ¨ Are you still “spotting”?

Actived: 1 days ago

URL: https://adventhealthimagingeastfl.com/app/uploads/2018/12/AdventHealth-HSG-History-Form.pdf