https://i.imgur.com/TvmpR4O.png I. PATIENT INFORMATION Title: (select one) [] Mr. [] Mrs. [X] Ms. [] Other First Name: Dakota Middle Name: (optional) N/A N/A Last Name: Woods Gender: (select one) [] Male [X] Female Date of Birth: 15/04/1999 Address: 2140 Senora Freeway ZIP / Postal Code: 6008 II. C...