Many times parents will send children to our practice without the parent or legal guardian present. If your child does now, or will be coming to Professional VisionCare by themselves in the future, please sign the consent below.

I, the undersigned, as the parent or legal guardian hereby authorize such diagnostic and medical treatment of such minor as may be considered necessary or appropriate under the circumstances for the treatment of any illness or injury of the minor. The attending doctor, appropriate staff, and Professional VisionCare and its employees shall not be responsible in any way for the consequences from said diagnostic and medical treatment and are hereby released from any and all claims and causes of action that may arise, grow out of, or be incident to such diagnosis or treatment in so far as the law allows and provided that these services are performed with ordinary care and to the best of their ability.

This consent is valid for the current and all future appointments unless revoked in writing. As parent/legal guardian, I give consent for my child to be treated if I have not accompanied him/her. I will be responsible for all charges not covered by insurance.