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prepayment
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Follow-up Prepayment
Follow-up Prepayment
$
50.00
$
Appointment Date
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What is the date of your appointment
Doctor or Specialist
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Please include the name of your care provider
Follow-up Prepayment quantity
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Category:
prepayment
Description
Description
Please include your appointment information and click to pay your follow-up prepayment fee.
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