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MEDICAL AND PHOTO RELEASE Nonparticipant Name: ___12159 W. Lake Houston Pkwy Houston, TX 77044 (281) 4587800Participant Date of Birth: ___Participant Address: ___ City: ___ State: ___ Zip: ___ Participant
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The wwwsummercreekbcorgwp-contentuploadsmedical release form is a document that allows individuals to authorize the release of their medical information.
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The wwwsummercreekbcorgwp-contentuploadsmedical release form may require information such as the individual's name, date of birth, medical provider information, and specific details of the information to be released.
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