nglish Emil Address Prima4 Care Physician' Existing Patient? }es u No Physician First & Larne/2c pTau Plosiermit'zi 2 7:6 7e? e,A, re' 3.3rat Home/Cell Phone Work Phone Do you use tobacco?' n Yes II yes, are you currently participating in a tobacco cessation program or do you intend to pin one? D Yes O