Drs. Erin & Randy Elliott
We realize that parents or legal guardians may not always be able to personally accompany their child to our office. However, Kentucky law dictates that a patient under the age of 18 CANNOT be treated without a parent or guardian’s consent. To ensure that your child may receive prompt dental care, please complete the following form/information.
Do hereby give consent for the following person or persons to request and authorize dental treatment for my child.
Add Additional Party
The above person(s) have my permission to received dental information and to make dental decisions on behalf of my child
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