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THE CHILDREN CLINIC 3 Fair wind Street P.O. Box EE 17887 Nassau, Bahamas Tel: (242) 3230266 Fax: (242) 6986703 Email: paedsclinic@yahoo.com Name of Patient: ___ Date of Birth: ___ CONSENT FOR PATIENT
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The wwwchildrensclnccomstorageappi hereby authorize form is a document used to grant permission for storage and usage of personal information.
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