Authorization for Medical Treatment of Children

Please correct the errors described below.

I/We being the parents or legal guardians of the following minor:

Do allow Kidology Pediatrics, PLLC permission to provide medical care and treatment to the above named.

I/We do hereby appoint the following (people other than Parent(s))

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To bring my child(ren) to the appointment in my absence and if necessary, to act on my behalf in authorizing medical treatment for the above named minor(s).

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