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Option 1: Open the form in your browser, download, open it in Acrobat Reader, fill it in, save, attach the saved document to the email address below and send it to us.
Option 2: Print out the completed form, and bring it when you come for your appointment.
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- PRACTICE INFORMATION
- NEW PATIENT FORMS
- HIGH DEDUCTIBLE PLANS
- AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION
- PATIENT REQUEST TO ACCESS RECORDS