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Check one I DO Initial each line below DO NOT want information about Mental Health released Other sensitive information Please confirm that you have put a checkmark and initialed all the protected information categories above regardless if they are applicable or not. Available to me under the policy affording coverage to me. I authorize Assignee to release any information acquired in the course of my examination and treatment to my insurance company. PAYMENT OPTIONS Please provide an abstract...

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Step 1: Obtain the Florida Orthopaedic Associates P form from the clinic or download it from their website.

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