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Patient Registration Form

Upload The Photo of Your Insurance Card (If Applicable)

Upload File
Upload supported file (Max 15MB)

Upload Doctor Order Document
(If Applicable)

Upload File
Upload supported file (Max 15MB)

Thanks for registering. See you there!

ADDRESS

570 Nevada St, Ste J & K,

Redlands, CA 92373

Tel: ‪(909) 206-6606

Fax: (909) 761-0119

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OPENING HOURS

Monday - Friday

9:00 am – 6:00 pm    

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