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This is the primary registration form for all patients. Bring this form with you on your first visit of the year, or if you have made changes to your information – new address, phone number, insurance, or anything else we should know. |
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If you don’t have insurance, please make sure to bring each of these items. |
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If you have insurance, please make sure to bring each of these items. |
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This form must be completed each year for all patients. If you are new, or if you are coming to your first visit for this year, fill out and bring this form. |
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This applications serves to qualify you for a reduced fee, or if qualified, no fee on your visit. Remember to check the Uninsured Checklist to make sure you have all the items you’ll need. |
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