div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 6button div class=ts-image amp-img class=ts-thumb alt=Page 6: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails6jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 7button div class=ts-image amp-img class=ts-thumb alt=Page 7: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails7jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 8button div class=ts-image amp-img class=ts-thumb alt=Page 8: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails8jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 9button div class=ts-image amp-img class=ts-thumb alt=Page 9: · 6120 East State Road 70 Bradenton FL 34203 Office: 941-752-1916 ASSIGNMENT OF INSURANCE BENEFITS RELEASE DEMAND Insurer and Patient Please Read the Following in its Entirety src=https:reader033vdocumentinreader033viewer20220423215f0b5dd77e708231d4302a4chtml5thumbnails9jpg width=142 height=106 layout=responsive amp-img divdiv