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Report Request Form

  • Date Format: MM slash DD slash YYYY
  • :
  • Date Format: MM slash DD slash YYYY
  • If school accommodations are needed please be as specific as possible regarding what you would like included in your report: (Example: Testing in a room free of distractions, etc...)

  • Cost

  • Please provide your method of payment below. Payment is due when your report is requested. Fax request to (405) 755-1875 or email to info@afeyecare.com. Please allow 2-3 weeks for report.

    Thank you

  • Date Format: MM slash DD slash YYYY
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