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Medical Request

Please be sure to include a telephone number where we can reach you if we have questions. Also please include email address or fax number if you need an immunization or physical form sent to you.  If you plan to pick a form up from our office, please let us know the approximate date so we can have it ready in our front office.  Please allow at least 3 business days if you are picking up a form. 

Medical Request Form

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