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WELCOME INTAKE FORM13372 Newport Ave. Ste. D Austin, CA 92780 Office: 714.730.2225 FAX: 714.730.2223Date Whom may we thank for referring you? Patient Name last name first namemiddleAddress City State
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Office 714 typically refers to a specific tax form or submission requirement related to business or individual filings, often related to income reporting.
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