Total health clinic

Questions 1–10

Complete the note. Write ONE WORD AND / OR A NUMBER in each gap.


Total Health Clinic

PATIENT DETAILS

Personal information

Example

   Name                        Julie Anne  ....Garcia.....

   Contact phone                  1.

   Date of birth                     2. , 1992

   Occupation                       works as a 3.

   Insurance company        4. Life Insurance


Details of the problem

   Type of problem                pain in her left 5.

   When it began                    6. ago

   Action already taken has taken painkillers and applied ice


Other information

   Sports played                     - belongs to a 7. club
                                                 - goes 8. regularly

   Medical history                 - injured her 9. last year
                                                - no allergies
                                                - no regular medication apart from 10.