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Restrictions are not to be deleted until a written signed request is received from the patient/legal representative. AUTHORIZATION FOR US TO SEND PERIODICAL UPDATES -MEDICAL COSMETIC NEW SERVICES If you would like to receive periodic bulletins on medical and cosmetic updates and new services offered by this practice via e-mail please sign below for authorization and provide us with your e-mail address. If there is a charge we will notify you and you may choose to withdraw or modify your...
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