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PATIENT FORMS

 

Patient Forms:

Release of Information (ROI) Form

 

Please print out or download the Release of Information form. Once completed, mail the form to:

 

              Dwayne Trujillo, MD

               P.O. Box 220089

              Anchorage, AK  99522

              (Do not mail the ROI form to the address printed on the form itself.)

Doctor with Files
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