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WE THANK YOU FOR THIS REFERRAL. Instructions: Please complete and fax to: (770) 4661585 Date: Patient Name: D.O.B.: Address: Phone: Email address: Insurance Company Insurance Number: Requesting Physician:
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We thank you for your support and cooperation.
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Anyone who has received help or support from others.
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You can express your gratitude verbally or in writing.
What is the purpose of we thank you for?
The purpose is to show appreciation and acknowledge the support received.
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Details about the support received and the impact it had.
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