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SAUL POLENBERG, O.D. JAMES G. CAYEA, O.D. TRACY SHEEDY, O.D. POUGKEEPSIE 845-471-3650
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Patient Forms
| For faster check-in service, please complete the following forms prior to arriving at our office. |
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| New Patients: | |
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MEDICAL HISTORY RECORD - Please print out and complete. |
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NOTICE OF PRIVACY PRACTICES - Please read. |
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ACKNOWLEDGMENT OF RECEIPT - Please print out and sign acknowledging you have read the Notice Of Privacy Practices. |
Copyright 2011 - All Rights Reserved