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YOUR PATIENT ADVOCATE:

ANNA SCHOEPHOERSTER

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PATIENT REGISTRATION

MEDICATIONS AND PRESCRIBERS

PROOF OF INCOME

**Uploading with form is optional but proof of income is required prior to submission of application for review.* Acceptable Forms of Income: Page 1 of your most recent tax return, 1099’s, W-2’s or 30 consecutive days of your most recent pay stubs unless otherwise discussed with your patient advocate. **

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