commonwealth internal medicine · restriction. however, if the practice does agree, it is bound by...

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Page 1: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing
Page 2: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing
Page 3: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing
Page 4: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing
Page 5: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing
Page 6: Commonwealth Internal Medicine · restriction. However, if the Practice does agree, it is bound by that agreement. I understand that I have the right to revoke this consent in writing