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LIFESPRINGS MEDICAL CENTRE

P.O Box 70877-00400, Nairobi.


Located behind Mulley`s Supermarket, Embakasi Tel: 0757 781 252
Email: lifesprings.medicalcentre@gmail.com

Name…………………………………………………………………Date…………………………………………
Gender…………………………. Age……………………………. Phone Number……………………………….
Patient Number…………………………………………………… Residence …………………………………….

Date Description Signature

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