I am a patient at Lakeside Medical. By signing this form, I give my consent to be treated by the nurse practitioner of this practice. I ask for and allow the practitioner/staff of Lakeside Medical to give me the needed medical treatment and services they recommend. I understand that treatment/services may include, but are not limited to: lab tests for prevention, diagnostic, and treatment purposes; screening tests (tests that can find an illness early, before a person shows signs of having the disease; this includes drug screens at the provider's discretion); and routine exams. My provider may need to photograph or videotape me to learn more about my health problems. I understand that no promises have been made to me about the results of any treatment plan and agree to provide specimen as requested.