Little Girl

Download the HIPAA Release Form here. You only need one of these forms for the entire family. Just write the names of all the children we will be seeing on the bottom line of the form.

Please Note: A parent or legal guardian must sign the consent on the Patient Information Form. Grandparents and step-parents cannot legally give consent** for treatment unless they are also the legal guardian, and have the proper paperwork to demonstrate that status. Therefore, a parent or legal guardian must accompany the child on their first visit unless the Patient Information Form is filled out and signed ahead of time, and sent with the responsible adult bringing the child to the office.

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