<%@ Page Title="New Patient" Language="C#" MasterPageFile="main.master" CodeBehind="patNew.aspx.cs" Inherits="FWA_MAIN.patNew" %>

New Patient

Patient ID:

First Name:

Last Name:

Middle Initial:

Weight (lbs):

Height (Ft):

Height (In):

Date of Birth:

Gender (M/F):

City:

Zip Code:

State:

Phone Number: