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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES REPORT OF EYE EXAM I hereby authorize PRINT DOCTORS FULL NAMEto give me this vision examination and to submit this report and recom mendations

Exam Date Signature of Eye Specialist Physician Li cense Number Business Address Form not valid after 1 year from exam date Telephone Date Corrective Lenses Issued Signature of Eye Associate Business Address Telephone Number

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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES REPORT OF EYE EXAM I hereby authorize PRINT DOCTORS FULL NAMEto give me this vision examination and to submit this report and recom mendations






Presentation on theme: "FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES REPORT OF EYE EXAM I hereby authorize PRINT DOCTORS FULL NAMEto give me this vision examination and to submit this report and recom mendations "— Presentation transcript: