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For more information on how your information can be used, please see "Privacy Policy" and "HIPAA Compliance" on our website.
A member of our team will contact you to discuss you concerns. Please allow 10-15 minutes for the phone call as we would like to fully understand your reasons for becoming a patient. This information will be shared with our doctors prior to your initial evaluation.
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This form was created inside of Classic City Orthodontics, LLC.