You are acknowledging by your signature that the risks, benefits, and alternatives to the treatment(s) or examinations have been explained to you and/or your child (including the alternative of no treatment or examination); that you or your child have had the opportunity to ask questions; that any questions have been or will be answered; and that you agree to pay for these examinations and/or treatments.
Should the provider deem it appropriate or necessary, they will attempt to contact you directly for discussion of any unusual or different findings, or if there appears to be a need to initiate or change a treatment plan considered to warrant your immediate input or approval. For any questions or concerns on our part, you may be reached at: