Required if a minor (under the age
of 18) is coming in for treatment without a parent or legal guardian
accompanying them. Complete the form and send it in with the child or fax it
before their appointment.
Click here for form.
These forms
require Adobe Acrobat Reader.
News
2012 looks like it will
bring several changes to health care. Be sure to know
what the limits and coverage of your policy are for the
new year.