Patient Registration

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Dr. Smith periodically sends updates via email

**Please note that we are not contracted with any Insurance at this time. We are not a Medicare provider and are not contracted with any State Funded policies.

Consent to treat: I understand by signing below I consent to medical treatment performed by Stephen L Smith, MD and his staff. I understand that no guarantee has been made regarding results of such treatment.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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