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I hereby give permission to Schodack Podiatry and any qualified staff to evaluate diagnose and treat my foot condition as may be deemed necessary. I recognize my financial obligation of any coinsurance co-pays or deductibles and non-covered services that may be required are due and payable at the time of service. RICHARD ALTWERGER D. P. M. TIMOTHY FAULER D. P. M. SCOTT ALTMAN D. P. M. SCHODACK PODIATRY PATIENT INFORMATION FORM PLEASE PRINT PLEASE PRESENT YOUR INSURANCE CARD UPON ARRIVAL Date...
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Richard Altwerger D is a form used to report the acquisition of direct or indirect control of a company.
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Information such as the name and address of the acquirer, the amount and nature of the securities being acquired, and the purpose of the acquisition.
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