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Get Treatment Guarantee Form (PDF Version) - Allianz Worldwide Care

Is this an extension to an existing Treatment Guarantee? Yes No If Yes , please provide the Treatment Guarantee ID reference number To the patient Please ensure that you complete sections 1, 2, 3 and 5, and that your doctor completes all questions in section 4. Failure to complete this form fully will delay our ability to guarantee your treatment as we may have to revert to you or the medical provider for further information. The patient s policy must be in force at the time of treat.

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