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Patient Registration

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Signed by Nina Blumenthal, MD
Signed On: November 7, 2023

Timestamp

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October 20, 2023 1:45 pm EST

Patient Registration Uploaded by Nina Blumenthal, MD - melissaclarkdesigns@gmail.com IP 99.127.28.37