• Authorization for Medical Treatment

    Authorization for Medical Treatment

    (For use of patients who are 18 years and older only)
  • I hereby consent to examinations, treatments and procedures (including emergency treatments) which may be deemed necessary by our physicians, their associates or staff.

    I authorize the staff of RDV Sportsplex Pediatrics to contact the following individuals by phone to deliver test results, gather additional information, or authorize care in the following order: (Note: Both parents/guardians are usually listed first, followed by any other individuals, if any

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