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My signature also certifies my understanding of and agreement with the above policies. I understand I am responsible for all charges not paid by insurance.
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What is my signature below confirms?
My signature below confirms that I have read and agree to the terms and conditions stated.
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The individual whose name appears on the document is required to file the signature below confirms.
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You can fill out the signature below confirms by printing your name and signing below it.
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The purpose of my signature below confirms is to acknowledge and accept the terms and conditions of the document.
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The signature below confirms must include the printed name and signature of the individual.
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