82 Ballards Corner Road
PO BOX 592
Hinesburg, VT 05461
Phone: 802-482-3155

Patient Information Form

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High Blood PressureLow Blood PressureHeart MurmurMitral Valve ProlapseArtificial Heart ValveCongenital Heart LesionHeart SurgeryHemophiliaPacemakerBlood DiseaseStrokeHIVHeart TroubleChest PainAnemiaThyroid DiseaseHepatitisKidney DiseaseUlcersLiver DiseaseDiabetesHypoglycemicGlaucomaPsychiatric CareAllergiesEmphysemaSinus TroubleShortness of BreathCancerLung DiseaseAsthmaRheumatic FeverChemo/RadiationRecent Weight LossEpilepsyFaintingArtificial Joints/HipsAlzheimer'sArthritis/GoutSwelling/Feet/Ankles/Hands

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