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2 Patient Information
Which doctor referred you to Estrella GI?
We are required by law to ask.
We are required by law to ask.
Please indicate your primary language


By indication, you give permission for us to discuss your medical health


Emergency Contact


I declare that the above answers are true and correct to the best of my knowledge. I understand that this office follows HIPAA guidelines for release of information.

Type your full legal name as signature
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