Parental Consent Form Book AppointmentParental Consent FormAs the parent or legal guardian of...Minor's Name(Required)...I give permission for her/him to have the following services performed:Planed Service(Required)I confirm that I have read and understand all information on the applicable forms for this treatment or service, and accept responsibility on my child’s behalf for any disclosures or liability described on those forms. I agree to supervise any home care procedures that are recommended as a result of the treatment.Full name of parent or guardian(Required) First Last Date(Required) MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
