Consent Form

GENERAL CONSENT FOR ACCOMPANYING CHILD TO DENTAL OFFICE FOR TREATMENT.

Please correct the errors described below.

THE PERMISSION TO ACCOMPANY MY CHILD TO HIS/HER DENTAL APPOINTMENT WITH DR. ERIN ELLIOTT OR DR. RANDALL H ELLIOTT.

IT IS UNDERSTOOD THAT THE ABOVE NOTED ADULT ACTS ON MY BEHALF AND IS PERMITTED TO MAKE DECISIONS REGARDING THE TREATMENT OF MY CHILD IN THE EVENT THAT I CANNOT BE REACHED.

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