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[et_pb_section bb_built=”1″][et_pb_row][et_pb_column type=”4_4″][et_pb_text admin_label=”NOVA Recovery LLC Credit Card Authorization Form” _builder_version=”3.19.18″]

[contact-form-7 id=”8836″ title=”NOVA Recovery LLC Credit Card Authorization Form”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Buda Drug Store — Patient Information Form (NOVA)” _builder_version=”3.19.18″]

[contact-form-7 id=”8838″ title=”Buda Drug Store — Patient Information Form (NOVA)”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”INFORMED CONSENT FOR TREATMENT” _builder_version=”3.19.18″]

[contact-form-7 id=”8839″ title=”INFORMED CONSENT FOR TREATMENT”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Client’s Rights” _builder_version=”3.19.18″]

[contact-form-7 id=”8840″ title=”Clients’ Rights”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Authorization for Emergency Medical Treatment” _builder_version=”3.19.18″]

[contact-form-7 id=”8841″ title=”Authorization for Emergency Medical Treatment”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Waiver of Liability and Hold Harmless Agreement” _builder_version=”3.19.18″]

[contact-form-7 id=”8843″ title=”Waiver of Liability and Hold Harmless Agreement”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Assignment of benefits” _builder_version=”3.19.18″]

[contact-form-7 id=”8844″ title=”Assignment of benefits”]

[/et_pb_text][et_pb_divider _builder_version=”3.19.18″ /][et_pb_text admin_label=”Authorization for Emergency Medical Treatment” _builder_version=”3.19.18″]

[contact-form-7 id=”8878″ title=”Authorization for Emergency Medical Treatment”]

[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]

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