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801.577.7055888.717.7578Open 365 days a year 8am8pm BY APPOINTMENTLOCATION MurrayTooeleREFERRAL STATUS New ReferralOrder RenewalPATIENT INFORMATION PATIENT NAME:DOB:WEIGHT’M:F:PHONE #:GLASSES:ALLERGIES:EMAIL:Please
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The form is a tax return required by the Internal Revenue Service (IRS) for reporting income.
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