I, {yourName}, give my permission to Natick Dental Partners and staff to discuss treatment provided and treatment recommended with the perons listed below until such time as I notify Natick Dental Partners and staff in writing that I am rescinding this authorization:
I, {parentlegalGuardian}, Parent or legal guardian, authorize {assignedLegal}
to consent to treatment for all dental Procedures for {nameOf} (name/names of
children). This proxy shall remain in force until such time as I rescind it.