div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imagea href=https:reader042vdocumentinreader042viewer20220406075eb8786feb468e0e5a21603ahtml5page1jpg target=_blank img data-url=texarkana-patient-registration-form-english2-patient-registration-form-emailhtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: Texarkana Patient Registration Form - English2 · PATIENT REGISTRATION FORM Email Postal Telephone How did you hear about our office circle one Newspaper a TV Billboard Friend loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader042vdocumentinreader042viewer20220406075eb8786feb468e0e5a21603ahtml5thumbnails1jpg width=140 height=200 adivdiv