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PhysiciansCertificationSpecialist 29777TELEGRAPHRD.,STE1451 SOUTHFIELD,MI48034 TEL:(248)9326400FAX:(248)9326362 RENEWALPATIENTACKNOWLEDGMENTANDDISCLAIMER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I/the patient
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