West Valley Pediatrics Consent Form

Please correct the errors described below.

The following individuals have my permission to bring my child to West Valley Pediatrics for medical care and treatment. I also authorize the same individuals to receive medical advice and information concerning my child, whether in office or over the phone. These individuals will also serve as emergency contacts for my child.

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I give my consent for the staff at West Valley Pediatrics to relay any imperative information by:

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