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Filling Prescription

Prescription Note

MEDICAL CONDITION

To ensure the safety and well-being of all attendees, we kindly request that you complete the following health declaration form before participating in our activity. This form will help us assess your current health status and minimize the risk of any potential health concerns.
 

Please note that submissions are valid up to 24 hours before the activity, so we recommend completing the form as soon as possible.
 

We appreciate your cooperation and understanding and look forward to seeing you at our event.

Patient general information

OTHER INFORMATION

DO YOU SMOKE?
DO YOU DRINK ALCOHOL?
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