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Kelly Wallace, N.D. Informed Consent to Treatment Flu Clinic (FAMILY) Name: Phone Number: Email: Date of Birth: Address: Age: Do you have any of the following conditions? Diabetes Daisy allergy Iodine
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Are you a target is a form used to identify individuals or organizations that may be the focus of an investigation or legal action.
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Are you a target form is typically filled out by providing information about the individual or organization being investigated, the nature of the investigation, and any relevant details.
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