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PERSONAL INFORMATION:
Name: ___
Date: ___
Parents name (if patient is under 18 yrs):
___
MaleFemale (please circle)Date of Birth: ___Address: ___
City: ___Zip: ___Home Phone: ___
Work Phone: ___ Cell
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I Understand Form Importance is a document that signifies the acknowledgment and comprehension of certain information or conditions.
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Individuals or entities who need to acknowledge and attest to certain information or conditions may be required to file an I Understand Form Importance.
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