By signing below, you provide consent that your child may receive appropriate medical care and treatment, as deemed necessary by the providers at Advanced Allergy & Asthma Associates. You also understand that a parent or legal guardian must be present in the building at all times in order for your child to receive treatment, testing, and/or injections.
You authorize the following individuals to accompany your child at office visits or injections:
DISCLAIMER: By typing your name below, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.