In the event that you are unable to accompany your child to their doctor’s appointment, we are required to obtain parental consent prior to treating a child. When parents are not immediately available, this can take time, and delay treatment.
This is to certify that the person/s listed below has my permission to authorize necessarymedical care for my child. This authorization will be in effect until revoked in writing by me oruntil my child(ren) turn(s) 18 year of age. I accept financial responsibility for necessary treatment and services.