Draft Rego Form

Practice Enrolment Form

Practice Name:  Millhouse Integrative Medical Centre                         Phone Number: (09) 537 4980

Address:            128 Millhouse Drive, Northpark, Auckland  2013        Fax Number:     (09) 537 5476

                         EDI Number       millhsed

Register with us

In order to get the best care possible, I agree to this Practice obtaining my records from my previous doctor. I also understand that I will be removed from their Practice Register.

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