Patient Registration

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Patient Information (Confidential)

Responsible Party

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Insurance Information

Insurance card(s) or proof of insurance must be presented at the time of service. Please note we are not a contracted provider with any insurance companies.

Disclosures to Friends and/or Family Members

The office of Dr. Neil p. Collins may discuss information regarding my account, billing, dental / health information including results, findings, and treatment options with the following family members and others listed below:

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