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Alexander Butkevich, MD
New patient forms
Please download the new patient forms (fillable, in PDF format), fill them out and bring to your appointment.
Notice of Privacy Practices (for your information only, no need to bring to appointment).
Protected Health Information (PHI) Forms
Authorization to obtain PHI (for third parties to release to us)
Authorization to release PHI (for us to release to a patient or a third party)
Instructions
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