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Patient Information > Forms

Patient Demographic Form
Notice of Health Information Practices
Patient Consent - Private Health Information
Self Pay - Sliding Fee Scale


 


 

About Us | Our Staff | Locations | Patient Info | Support Us | Contact Us | Home
 Mercy Children’s Clinic is a qualified tax-exempt organization under Section 501(c)(3) of the IRS Code of 1986.
 All donations made to Mercy Children’s Clinic are tax-deductible.
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