Get the free custom ancillaries request form - ixinity
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CUSTOM ANCILLARIES
REQUEST FORM
Fax both sides of completed form to 18887479329Custom ancillary supplies are available at no additional cost with TRINITY. Once selected, patients will be contacted
to
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What is custom ancillaries request form?
Custom ancillaries request form is a form used to request additional services or products that are not part of the standard offerings.
Who is required to file custom ancillaries request form?
Any individual or organization who wishes to request custom ancillaries must file the request form.
How to fill out custom ancillaries request form?
To fill out the custom ancillaries request form, the requester needs to provide their contact information, details of the requested ancillary, and any other relevant information.
What is the purpose of custom ancillaries request form?
The purpose of the custom ancillaries request form is to formally request additional services or products that are not part of the standard offerings.
What information must be reported on custom ancillaries request form?
The custom ancillaries request form must include the requester's contact information, details of the requested ancillary, and any other relevant information.
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