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Photo Upload Form
Photo upload form in English and French. With name and email fields for uploader info and a message box for comments
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Language
English (US)
1
Patient Name
First Name
Last Name
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2
Date of Birth
-
Date
Year
Month
Day
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3
Upload File/Photo
Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
Upload a File
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4
Comments (optional)
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