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Submission: On March 14 via manual from US — Scanned from DE
Submission: On March 14 via manual from US — Scanned from DE
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WE CAN’T WAIT TO SEE YOU, JEREMY! intro.description.VT PLEASE READ AND E-SIGN THE DOCUMENTS BELOW Acknowledgment Of Receipt Of Privacy Practices Read and sign Authorization To Share Health Information Read and sign Complete my exam forms What if I can’t complete all of my forms right now? We know you’re busy. You can exit at any point and come back later to finish. Your eye exam at Triangle Visions Optometry Cary Kildaire Farm Patient Jeremy Hopkins Doctor Elizabeth Gunst When March 24th, 2023 at 8:00 AM Date of Birth 10/22/1977