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Midwest Clinical Research Center One Elizabeth Place, Suite G3 |
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When you arrive at our office, we will provide you with paperwork to complete. Optional: If you have access to a printer, you may complete one of the forms below and bring a printed copy of the form to your appointment: Microsoft Word version (can be typed or hand written):Demographics & Authorization to Release Medical Records forms (Word) or PDF version (hand written only -- requires Adobe acrobat):Demographics & Authorization to Release Medical Records forms (PDF) Forms update: 1-25-2011 |