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New patient paperwork patient paperwork (March 2… · MEDICARE PATIENTS: We are participating providers with Medicare and will bill Medicare for all of your covered charges. If you

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Page 1: New patient paperwork patient paperwork (March 2… · MEDICARE PATIENTS: We are participating providers with Medicare and will bill Medicare for all of your covered charges. If you
Page 2: New patient paperwork patient paperwork (March 2… · MEDICARE PATIENTS: We are participating providers with Medicare and will bill Medicare for all of your covered charges. If you
Page 3: New patient paperwork patient paperwork (March 2… · MEDICARE PATIENTS: We are participating providers with Medicare and will bill Medicare for all of your covered charges. If you
Page 4: New patient paperwork patient paperwork (March 2… · MEDICARE PATIENTS: We are participating providers with Medicare and will bill Medicare for all of your covered charges. If you