Release of Records

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  • Release of Records

  • If by mail, send to: Dr. Louis M. Giordano 864 Hooper Road Endwell, NY 13760 607-748-4151 (phone) 607-484-0061 (fax)
  • This record release is for:

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  • Electronic Signature (E-Signature) Agreement

  • Electronic Signature:

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