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Advisory to Consult With a Physician

To comply with NJ PL 2009 (C.45:2C-5a-2), the Intern Clinic of the Eastern School of Acupuncture and Traditional Medicine requests that you read and sign the following statement.

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Patient(Required)
Clinical Supervisor
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We, the undersigned, affirm that the clinical supervisor has advised the patient to consult a licensed physician regarding the condition for which the patient is seeking treatment at the intern clinic of the Eastern School of Acupuncture and Traditional Medicine.(Required)

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