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Our online sign-up process is a secure and simple way to provide your medical history and demographic information. Filling out this form does not result in any automatic charges, and does not commit you to any contract. You will not be charged until after your first consultation visit, in person or by phone, at which time you can decide whether you wish to become a member. Your information is stored securely with protection that exceeds the requirements for HIPAA compliance. Completing this form in no way commits or obligates Cannon Family Practice to accept you as a patient. 

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