In order to protect your child’s privacy, we need your written permission to leave detailed phone, email or text messages regarding your child, including messages that contain health and/or billing information. Please note that current Notice of Privacy Practices allows us to contact you without written approval with a courtesy reminder regarding upcoming appointments.
Disclaimer: By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
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