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Dr. Barbara Custer, O.M.D. 147 Lolita Dr., Ste J, Mill Valley, CA 94941 P: 415.383.3040 F: 415.383.2766STATEMENT OF INFORMED CONSENT hereby request and consent to the performance of acupuncture and
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Barbara Custer O is a form used for reporting certain financial information.
Individuals or entities who meet the criteria set by the governing body are required to file Barbara Custer O.
Barbara Custer O can be filled out by providing all the necessary financial information in the designated sections of the form.
The purpose of Barbara Custer O is to disclose relevant financial information to the appropriate authorities.
Barbara Custer O requires the reporting of specific financial data as outlined in the form.
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