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Fowler Kennedy Sport Medicine Clinic
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Service Name:
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Level 1:
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Level 2:
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Level 3:
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Level 4:
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Level 5:
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Former Name:
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Phone Numbers:
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Office:
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Toll-Free:
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TTY:
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Crisis:
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After Hours:
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Fax:
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Email:
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Website:
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Mailing Information:
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c/o:
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Street Address: (if different)
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Building:
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Address:
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Room:
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Intersection:
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Accessibility:
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Accessibility Notes:
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Hours:
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Dates Available:
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Executive:
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Name:
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Organization:
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Phone:
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Email:
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Executive 2:
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Name:
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Organization:
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Phone:
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Email:
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Public Contact:
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Name:
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Organization:
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Phone:
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Email:
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Public Contact 2:
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Name:
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Title:
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Organization:
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Phone:
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Email:
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Provider Contact:
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Name:
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(if different)
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Title:
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Organization:
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Phone:
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Email:
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Description:
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Meetings:
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Provider Notes:
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LHIN Funded:
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Funding:
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Fees:
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Application:
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Application Notes:
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Target Population/Eligibility:
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Age:
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Languages: |
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Language Note:
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Area(s) Served:
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Year Established:
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Legal Status:
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YouTube Video #1
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URL:
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Title:
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YouTube Video #2
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URL:
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Title:
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YouTube Video #3
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URL:
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Title:
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Please ensure that you include your name, email address and telephone number in case we need to contact you to confirm your changes.
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Source:
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Name:
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Title:
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Organization:
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Phone:
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Email:
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Types of Changes Submitted:
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