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Please complete the appropriate forms and bring them with you or fax them to our office at 310-657-0986

        Please complete this registration information and bring it with you to the first appointment.


         Change of information? Let us know by completing these forms.

         Please send these forms to your previous provider to have medical records transferred to Roxbury Pediatrics.


         We are sad to see you leave. If you'd like to request a transfer of medical records to another office, please sign and return these forms            to have medical records transferred to another provider.




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