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Forms

All forms are separated below.

Please contact Smaldore Family Practice regarding
follow up questions or concerns.

1. PATIENT FINANCIAL RESP. STATMENT /     Patient Financial Responsibility Form 2

2. Patient Financial Policy Statement Form: PG. 1     /   Patient Financial Policy Statement Form: PG. 2

3. CareFirst PCMH Form 1     /     CareFirst PCMH Form 2

4. Authorization for Answering Machine & Med Info

5. Request for Release of Medical Records

6. Medical History Form: PG.1      /          Medical History Form: PG.2

 

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