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Get Reflection Ridge Chiropractic Authorization for the Release of Medical Records

Authorization for the Release of Medical Records Patient Name: Date of Birth: (also list maiden name/other names used) I hereby request and authorize: Reflection Ridge Chiropractic 2290 N. Tyler Rd.,.

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  4. Be sure the data you fill in Reflection Ridge Chiropractic Authorization for the Release of Medical Records is updated and accurate.
  5. Include the date to the template with the Date option.
  6. Click the Sign button and create a digital signature. There are three available alternatives; typing, drawing, or uploading one.
  7. Re-check each and every field has been filled in correctly.
  8. Click Done in the top right corne to save or send the file. There are many options for getting the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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