Consent of medical care
Welcome to Elderberry Holistic Health Clinic
Name
First Name
Last Name
Aknowldgement
*
I, First Name Last Name, do hereby agree and give my consent to Elderberry Holistic Health to furnish medical care and treatment considered necessary and proper in diagnosing or treating my physical and mental condition. I understand my physician may referral to other physicians that would be better suited to my medical condtion or care.
Signature
Date of Signature
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Month
-
Day
Year
Date
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