New patient registration and medical history.
| Field | Type | Required |
|---|---|---|
| Full Name | Text | Required |
| Date of Birth | Date | Required |
| Gender | Select | Optional |
| Email Address | Required | |
| Phone Number | Tel | Required |
| Insurance Provider | Text | Optional |
| Policy Number | Text | Optional |
| Known Allergies | Textarea | Optional |
| Current Medications | Textarea | Optional |
| Pre-existing Conditions | Checkbox | Optional |
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