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Dear prospective patient,

Thank you for coming to this page.  If you are filling out this information, you are starting the process of becoming one of our monthly members.  Congratulations on taking the first step on your journey to wellness!  Once you complete this form, we will be in touch with you to set up an initial appointment.

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Madina Medicine, PLLC

1106 Clayton Lane, Suite 521W, Austin, TX 78723

phone: (512) 960-2522 

fax: (512) 382-7270

info@madinamedicine.com

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