Spectrumbehavioralhealthny.com-Parental Consent to Treatment

SPECTRUM BEHAVIORAL HEALTH

New In-take Fax: 845-485-8780

Poughkeepsie Fax: 845-452-7546 / Fishkill Fax: 845-897-3376 / Kingston Fax: 845-331-1479
Parental Consent to Treatment
Your child may be prescribed medication for his/her psychiatric condition.

All medicines we use are FDA approved. However, many of these medicines are used "off label" for psychiatric disorders in children and adolescents.

Medications are given with the idea of improving symptoms. Decisions are based on clinical judgment in consideration of current psychiatric literature.

Signing this forms grants permission for psychiatrists or nurse practitioners to provide the medicine that may have a therapeutic effect on the symptoms that we are trying to alleviate.

If at any time you wish additional information about the medications being prescribed, feel free to ask your psychiatrist/nurse practitioner for additional information.
Patient Name*

First NameLast Name
Parent/Legal Guardian Signature to indicate permission to medicate your child:*

Clear
Date*

MonthDayYear
Print Parent / Legal Guardian First and Last Name

First NameLast Name
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