PEDIATRIC PATIENT INTRODUCTION

  • PEDIATRIC PATIENT INTRODUCTION

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  • PEDIATRIC CASE HISTORY

  • AUTHORIZATION FOR CARE OF MINOR

  • I HEREBY AUTHORIZE THIS OFFICE AND ITS DOCTOR(S) TO ADMINISTER CARE AS THEY SO DEEM NECESSARY TO MY SON/DAUGHTER/WARD (UPON APPROVAL OF PARENT OR GUARDIAN)

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  • I REALIZE THAT IAM RESPONSIBLE FOR ALL FEES CHARGED BY THIS OFFICE AND IAGREE TO PAY FOR ALL SERVICES PROVIDED.

    X-RAYS REMAIN THE PROPERTY OF TH ISOFFICE.

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