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INFORMED CONSENT FORMName: Address: City: State: ZIP Email: Phone: How did you hear about us? !I am over the age of 18!!!!!!!!I am under the age of 18 my parent or legal guardian is filling out and signingthis form on my behalfI am not pregnant or nursingI do not have a pacemaker, magnetic chip implant, including an insulinregulator, or any other electron.

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