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THIS IS NOT A FILLABLE DOCUMENT-PLEASE PRINT, COMPLETE AND RETURN THIS DOCUMENT TO THE OFFICE

THIS IS NOT A FILLABLE DOCUMENT-PLEASE PRINT, COMPLETE AND RETURN THIS DOCUMENT TO THE OFFICE 2025

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4.8 out of 5

34 votes

The document is a patient registration form for the Maryland Vision Institute, LLC, which requires patients to provide personal, insurance, and medical history information. It includes sections for patient contact details, insurance coverage (vision and health), emergency contacts, consent for treatment, cancellation policies, and health history. Additionally, it explains the differences between routine and medical eye exams regarding insurance coverage. The form emphasizes the importance of accurate information and outlines policies related to cancellations and payment responsibilities.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (34 Votes)
2016	4 Satisfied (39 Votes)

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