, the parent or legal guardian of the minor(s) listed below:
Do hereby authorize medical treatment by Kid Approved Pediatrics, PLLC
Name of the adult person(s) authorized to bring minor child in for medical treatment.
Telephone number(s) where parent or guardian can be reached.
Your message will be encrypted and can only be read by Kid Approved Pediatrics.
Fax: (972) 674-2613
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