Raider, call and get another copy. fill in just the spaces for the last 3 doctors visits that pertain to why you receive disability. for example if you are getting it because of more than one disease or condition make sure the last 3 visits you list reflect that. so if its say neurological and pulmonary make sure that you put your last visit for neurological and pulmonary even if your actual last 3 doctors visits were not one of them. only fill in the boxes. stop mid word if you have to do not write anything else on the form or in remarks section. this will cause your form to have to be evaluated by a person and you dont want that.