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8380 Six Forks Road, Suite 102, Raleigh, NC 27615 Phone: (919) 8968520 Fax: (919) 8968534 Website: www.lrofnc.com SELF PAY AGREEMENT FORM Today's Date: Client Name: MR Number: DOB: SS#: At Life Resources

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What is todays date - life?

Today's date is March 25, 2022.

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The purpose of today's date - life is to keep track of the current date.

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