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Get STERILIZATION CONSENT FORM (NON-FEDERALLY FUNDED) - Cdph Ca

IZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS. CONSENT TO STERILIZATION STATEMENT OF PERSON OBTAINING CONSENT I have asked for and received information about sterilization from Before signed the (Name of Individual) (Doctor or Clinic) When I first asked for the information, I was told that the decision to be sterilized is completely up to me. I was told that I could decide not to be sterilized. If I decide not.

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