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PLANNED PARENTHOOD OF SOUTHWEST & CENTRAL FLORIDA AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Revised 12/06 Reviewed 12/11 DATE: I hereby request and authorize Planned Parenthood: 736 Central

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Visit the Planned Parenthood of Southwest's website or go to one of their local clinics.

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If you have any questions or need assistance, don't hesitate to ask the staff at Planned Parenthood of Southwest for help.

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Planned Parenthood of Southwest provides reproductive health services and education in the southwest region.

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