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Get the free Mail or Fax to: Release of Information 121 Inner Belt Road ...

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Fax 8173857568PERMISSION TO RELEASE MEDICAL RECORDS Patients Name: Date of Birth: Address, City, State, Zip: As a patient, or parent/guardian of a patient, of Arlington Center for Dermatology, I authorize
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Mail or fax to is a method of submitting documents or information through postal mail or fax machine.
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