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shondrasmithmd.com · 2019-09-12 · Patient Name: Chart # Date: Day time phone # Evening phone # Emergency phone # Welcome to our practice. As a new patient, we will discuss your

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Page 1: shondrasmithmd.com · 2019-09-12 · Patient Name: Chart # Date: Day time phone # Evening phone # Emergency phone # Welcome to our practice. As a new patient, we will discuss your
Page 2: shondrasmithmd.com · 2019-09-12 · Patient Name: Chart # Date: Day time phone # Evening phone # Emergency phone # Welcome to our practice. As a new patient, we will discuss your
Page 3: shondrasmithmd.com · 2019-09-12 · Patient Name: Chart # Date: Day time phone # Evening phone # Emergency phone # Welcome to our practice. As a new patient, we will discuss your
Page 4: shondrasmithmd.com · 2019-09-12 · Patient Name: Chart # Date: Day time phone # Evening phone # Emergency phone # Welcome to our practice. As a new patient, we will discuss your

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