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Patient Forms

Click on the link below to download the PDF form:


FORM:DR. ALICIA B. FELDMAN & DR. GREGORY A. MOORE - PATIENT INTAKE FORM

FORM:PATIENT RIGHTS/NOTICE OF PRIVACY PRACTICES (HIPAA)

FORM: AUTHORIZATION TO USE/DISCLOSE HEALTH INFORMATION
Complete and return this form by mail, fax or in person to:

NeuroSpine Institute

Att: Medical Records
74-B Centennial Loop Suite 100
Eugene, OR 97401
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74-B Centennial Loop, Suite 100, Eugene, Oregon 97401
Phone: 541-686-3791 | Fax: 541-686-3795


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