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Patient's Own Frame Waiver

Frame Waiver

I am aware that I am using my own frame and I will not hold my eye doctor, office staff or the optical lab responsible for damages upon insertion of lenses in the frame or during frame adjustments.

Date: ____________________

Patient or legal guardian’s name:          ____________________________________

Patient or legal guardian’s signature:     ____________________________________
Renuncia a Marcos

Soy consciente de que estoy usando mi propio marco y no voy a culpar a mi oculista, personal de oficina o laboratorio óptico responsable de daños al insertar lentes en el marco o durante los ajustes.

Fecha: ____________________

Patiente o guardián legal nombre:        ____________________________________

Patiente o guardián legal firma:             ____________________________________

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