Otherwise, print out and complete this
form then fax it back to:
Patricia Martin Stanford, PA
8402 Papelon Way
Jacksonville, FL 32217
Phone: (904) 733-1732
Fax: (904) 739-2347
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professional medical advice. Additionally, the legal information provided is not
state-specific; the laws of each state may differ. Consult a doctor or contact us for advice about your particular situation.
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