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FOOT CLINIC Form.pdfEmail Chiropodist Foot Specialist Date of Birth City ext. (work) (phone / email) % standing Occupation Height Family Physician Weight Time spent sitting Referred

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Page 1: FOOT CLINIC Form.pdfEmail Chiropodist Foot Specialist Date of Birth City ext. (work) (phone / email) % standing Occupation Height Family Physician Weight Time spent sitting Referred