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PET/CT Scheduling Form 881 Their Parkway Medford, OR 97504Scheduling: (541) 6080350 Scheduling fax: (541) 6080376PATIENT INFORMATION Patient Name Age: DOB: MaleFemaleHt. Wt. SS# Home Number () Work/Cell

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Form 612 Revised June is a tax form used to report specific financial information to the relevant tax authority.

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Form 612 Revised June may require reporting of income, deductions, credits, and other relevant financial details as specified by the tax authority.

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