Patient Forms - Sujee's Optometrists

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Particulars of Patient

Person responsible for account

Same as above

Medical Aid

Next of Kin

Preferred method of Communication

I hereby confirm that I have read, was explained and understood the agreement terms and conditions as set out herein.
I hereby accept the Sujees Optometrists' Agreement Terms

I agree to give Sujees Optometrists permission to check my medical aid benefits and savings balances.

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