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#130 8700 200Street Langley, BC V2Y 0K1 Phone: 6043713939 Fax 6043710485 www.willoughbyfamilychiro.ca Dr. Sooner & Dr. McManusChart#: NEW PATIENT CHILD INTAKE FORM Name: Date of Birth: (M/D/Y) Age:
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Spooner amp dr stands for Spooner Amendment Departure Report, which is a document required to be filed by certain individuals who are departing from the US.
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Individuals who are deemed expatriates or long-term residents of the US are required to file a Spooner Amendment Departure Report.
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