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Please fill out and bring in with you. Thanks! | 24k | v. 1 | May 19, 2019, 1:58 PM | Michael Gombatz | |
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Please fill out and bring in with you. Thanks! | 25k | v. 1 | May 19, 2019, 1:58 PM | Michael Gombatz | |
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HIPAA Authorization and Consent Release of Information - Please print, fill out, and bring in with you. Thanks! | 4199k | v. 1 | Feb 27, 2017, 4:57 PM | Michael Gombatz | |
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If required, please fill out and bring in with you. Thanks! | 69k | v. 1 | Feb 27, 2017, 4:48 PM | Michael Gombatz |