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Thank you for considering Keck Medicine for your medical needs. To provide the most comprehensive care, please complete the Patient Demographic Information form. Once we recieve your personal information, you will recieve an active link with the email address you provided to submit additional medical and clinical report information that will let us determine the most appropriate treatment and next steps.

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Service Agreement

Information collected from this website or provided on any form you have submitted through the website is used only in conjunction with an interest by the user in obtaining additional information at Keck Medicine. This information is not considered Protected Health Information (PHI) and will be used to contact you because you have requested that you be contacted. In addition, information provided on the website or in any response to you is not and cannot be considered medical advice or treatment.

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