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WELCOME Step 1PATIENT REGISTRATIONPatient PLEASE COMPLETE BOTH SIDES OF THE QUESTIONNAIRE BY FOLLOWING THE THREE EASY STEPS IN BLACK INK. Step 2INSURANCEEmail Address Who is responsible for this account?

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Welcome Please Complete Both is a form that needs to be filled out with certain required information.

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All individuals or entities specified by the governing body are required to file Welcome Please Complete Both form.

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The purpose of Welcome Please Complete Both is to collect specific information for regulatory or compliance purposes.

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Information such as name, address, contact details, and other relevant data may be required to be reported on Welcome Please Complete Both.

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