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In order to minimize the extra time required at your first visit, download the document below and complete the information before you arrive for your first visit.

Please complete all sections and items on all three pages of this document.

Patient Information And Consent Form - click here to download

This document is presented in the PDF format. In order to read and print this document, you will need to have the Adobe Reader or equivalent.

You can download the Adobe Reader, without charge, here: Download the Adobe Acrobat Reader for free

 
  Copyright © 2009. Janice L. Birney, M.D.. All rights reserved.