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Fox Cities Eye Clinic
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                  Ages 65+

                  Please print and fill out the forms below prior to your next appointment.


                  Patient History Form 1 66.9KB
                  Patient History Form 2 68.9KB
                  Medicare Signature Form 56.9KB
                  Refraction Form 33.1KB
                  Financial Policy 75.5KB

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                    1301 East Northland Ave. Suite A

                    Appleton WI, 54911


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                    foxcitieseye@foxcitieseye.com


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                    920-734-8714


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