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New Patient forms
*Click on the links below to fill out forms or download PDF.*
All 5 forms must be filled out.
1. New Patient Information
2. HIPAA
3. Consent to Use and Disclosure
4. Assignment of Benefits
5. Refraction and Services Fee
Download PDF
* Haga clic en los enlaces a continuación para completar formularios o descargar PDF. *
1. Information de Nuevos Pacientes
2. HIPAA
3. Consentimiento
4. Acuerdo Financiero
5. Refraccion Servicio y Las Cuotas
Descargar PDF
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