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Get Allergy Station Release Of Antigen Consent Form

BIRTH: I request that my own or my child s allergy extract prepared by: Be administered under the supervision of Travis A. Miller, MD Signature of Patient Date: By signing this form, the supervising physician acknowledges his or her medical responsibilities. These responsibilities include reading the Allergy Immunotherapy Instructions before beginning this therapy, doing patient assessment before giving injections and treatment of untoward or local and or systemic all.

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