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  • AUTHORIZATION TO PERFORM TESTS

    Please complete this form in its entirety.
  • I have been informed and I understand that I will be billed separately by the laboratory. If I do not have insurance or if my insurance does not cover any of these tests, I acknowledge that I am solely responsible for satisfying payment of those fees.

    I have been advised to contact this office for test results in 10-12 working days. Please note that all patients must come back into the office for consultation for abnormal labs, STD testing and HIV test results.

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