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CITY OF ALEXANDRIA8236 WEST MAIN STREET ALEXANDRIA, KY 41001 (859) 6354125 FAX (859) 6354127PLANNING AND ZONING COMMISSIONAPPLICATION FOR IDENTIFICATION PLAT APPROVAL Date Submitted: ___ Project Number:

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Patients visiting JSA Eye Center or seeking eye care services from JSA Eye Center need to fill out the patient information form found on jsaeyedocs.com/wp-content/uploads/patient information.

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Jsaeyedocscom wp-content uploadspatient information is a document that contains confidential medical information of patients.

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