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2629 North gate Drive Iowa City, IA 52245Ph: 319.338.3623 Fax: 319.338.7289CONSENT TO RELEASE OF INFORMATIONPlease PRINT (except signatures) and provide complete answers (and addresses) in each section.
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Eye physicians and surgeons are medical doctors who specialize in the diagnosis, treatment, and surgical management of eye diseases and conditions.
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Healthcare professionals, specifically eye physicians and surgeons, are required to file eye physicians and surgeons documentation for reporting purposes.
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