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Patient Information Form Randall J Russell, DDS6240 S. Main Street Suite 255 Aurora, CO 800167208701451Patient Name Date of Carthage Marital Status Today's DateAddressCity/StateZipEmployer NameOccupationEmail
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Under 18 refers to individuals who are not yet 18 years old.
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Information such as income earned by the minor, any taxes withheld, and other relevant financial details.
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