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By dropping off, you authorize the doctor to treat as deemed necessary. There will be a hospitalization < 12 hours charge of $28 for drop-off appointments. (If an estimate is needed prior to treatment you must be reachable)
(Required)
If the Doctor feels lab-work or X-rays are appropriate, do you want to authorize such tests?(Required)
(Required)
The Doctor or Technician will call after the examination to go over treatment plan:(Required)