Russ Merrick, EA & Associates

Appointments

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Name: Address: City: State/Province: Zip/Postal: Email: Phone:

Are you a current client? Yes No How did you hear about us? Best time(s) to call? Anytime Morning Noon Afternoon Evening

Preferred day(s) of the week for an appointment?

Any Day

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Preferred time(s) for an appointment?

Any Time

Morning

Noon

Afternoon

Evening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):