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ANTI AJU, D.O., P.A. 2150 LAKESIDE BOULEVARD, SUITE 225E RICHARDSON, TX 75020 pH: 9729075230 Fax: 9729075231 REGISTRATION & CONSENTS FORM Patient Name: Date of Birth: Last Sex: M F First Middle SSN:

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3. Begin by entering your full name in the designated field. Make sure to write your name exactly as it appears on your identification documents.
4. Provide your date of birth in the appropriate format as mentioned on the form. Double-check the accuracy of this information.
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7. Carefully read any statements or declarations on the form and ensure you understand them. If you agree with the provided terms and conditions, you may be required to sign and date the document.
8. If the form requests any supporting documentation, make sure to attach the required files to the form. This could include identification documents, proof of address, or any other relevant paperwork.
9. Before submitting the form, go through each section to verify that you have provided accurate and complete information. Look out for any errors or missing information that needs to be corrected.
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