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EYECARE ASSOCIATES OF COLUMBUS, P.C.

EYECARE ASSOCIATES OF COLUMBUS, P.C. Dr. Daniel K Mickey, Dr. Kerry J Krings, Dr. Ryan B Stevens. 1371 29 th Avenue, Columbus NE 68601. Phone: 402-564-0545

EYECARE ASSOCIATES OF COLUMBUS, P.C. Fax: 402-564-0078

EYECARE ASSOCIATES OF COLUMBUS, P.C. Dr. Daniel K Mickey, Dr. Kerry J Krings, Dr. Ryan B Stevens. 1371 29 th Avenue, Columbus NE 68601. Phone: 402-564-0545

Clarkson Eyecare PATIENT HISTORY QUESTIONNAIRE

(shortness of breath, wheezing) Heart Problems Endocrine Problems Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Clarkson Eyecare PATIENT HISTORY QUESTIONNAIRE

Welcome! INSURANCE IN CASE OF EMERGENCY, CONTACT PATIENT ...

made on my behalf to Primary Eyecare Group for services furnished me by Primary Eyecare Group. I authorize any holder of medical information about me to release to the Division of

EyeCare Associates of Texas, P.A.

EyeCare Associates of Texas, P.A. REGISTRATION FORM Please fill out completely. Insurance may not pay if we cannot provide all this information.

Seniors EyeCare Program

Seniors EyeCare Program The Seniors EyeCare Program ensures that every senior has access to medical eye care and promotes annual, dilated eye exams.

ATLANTIS EYECARE

CONSENT FOR PURPOSES OF TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS I consent to the use or disclosure of my protected health Information by Atlantis Eyecare for the purpose of diagnosing or providing treatment to me, obtaining payment for my health care bills or to conduct health care I ...

We treat your eyes amazingly well. Eyecare: Cost-effective ...

We treat your eyes amazingly well. Eyecare: Cost-effective Preventive Care Vision care is a low-cost benefit people appreciate; and with 75% of Americans requiring vision correction, it’s a benefit people need.

Welcome Dr[1]. Gago PR

November 29, 2007 Welcome Dr. Gago.doc-more-For More Information: Pamela Gillies (734) 761-2352 Pamela.gillies@tlcmi.com TLC Eyecare & Laser Centers of Michigan, Welcomes a New Doctor, Luis Gago, M.D. to the Practice TLC Eyecare & Laser Centers of Michigan welcomes a new doctor, Luis C. Gago, M ...

ADVANTICA EYECARE CORPORATE OFFICE Arbor Shoreline Office ...

ADVANTICA EYECARE CORPORATE OFFICE Arbor Shoreline Office Park - 19321-C US Highway 19 North - Suite 320 - Clearwater, FL 33764 Telephone: 727.538.7719 - Toll Free: 866.354.2020 SERVICE CENTER 3290 Pine Orchard Lane - Suite D - Ellicott City, MD 21042 Telephone: 410.418.4414 - Toll Free: 866.425 ...