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Get BackTO BEING YOU

Helpful Forms

New Clients: Print and fill out these forms and email them to me at info@getbacktobeingyou.com

Policy Agreement  
Privacy Agreement  
Your Information  

 


Please fill out the Credit/Debit card form:

If you would like to pay your fee or copay by credit card
If you have an unpaid deductible for this year
 

Please enter all information except credit card number, expiration date and CCV number. You can give these to me over the phone.

 

 

Credit/Debit Card Form  

 

 

 

Note: To download Adobe Acrobat Reader for free, click here.

 

 

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Helpful Forms

Click here to view and print forms for your appointment.

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