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Files & Forms
Patient Demographics
Important Info
This form is required for all new patients with or without insurance. We also ask that if you have had a change of address or phone number that you update that information with our clinic. You can also use this form to update emergency contacts and people who you do or not authorize to have access to your protected healthcare information. Feel free to print this form and bring it in, mail it, or send it to our email billing@statcareclinics.com
Files & Forms: Files
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