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New Patient Information Form

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  • Insurance

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  • The above information is true to the best of my knowledge. I authorize Sobel Eye Care, PLLC to bill my insurance company and I allow my insurance benefits to be paid directly to Sobel Eye Care, PLLC. I understand that I am financially responsible for any balance not covered by my insurance. I also authorize Sobel Eye Care, PLLC or my insurance company to release any information required to process my claims.
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