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WWW.thephysicians.com PATIENT REGISTRATION SHEET Patient NAME: FIRST NAME MIDDLE NAME LAST NAME What is your MAILING ADDRESS? STREET OR P.O. BOX CITY APT# STATE ZIP What is your EMAIL ADDRESS? May
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Your mailing address is the address where you can receive mail and packages.
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Anyone who wants to receive mail or packages at a specific address is required to provide a mailing address.
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You can fill out your mailing address by providing your street address, city, state, and ZIP code.
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The purpose of your mailing address is to ensure that mail and packages are delivered to the correct location.
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The information that must be reported on your mailing address includes your street address, city, state, and ZIP code.
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