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The consent form you sign gives the physicians and staff of Tyler Oral Facial Surgery permission to treat your child. Notice to the Parents or Legal Guardians of a Minor If your child is a minor you must be present at your child s initial visit to sign the parental consent form below and provide your child s social security number. Without a signed consent form we cannot legally treat a minor child. the course of treatment photographs may be taken for clinical or educational purposes. If you are not the parent but are the legal guardian you will need to provide legal documentation that you are the legal guardian* This information will be kept in the child s file. Minor Accompanied by others If I am unable to accompany my child to the appointment the below listed individuals have my permission accompany my child. This agreement is required in order for the unaccompanied child to be seen and treated* Initials CONSENT TO TREAT MINOR I authorize Tyler Oral Facial Surgery to treat and provide any healthcare services to my child that the provider deem necessary for treatment and/or diagnosis including biopsies. I also understand in Unaccompanied Minors I grant permission to treat and provide any healthcare services to my child that the provider deems necessary for treatment if my child arrives at the office unaccompanied* Initials I further acknowledge this consent will remain in effect until either I revoke in writing and delivered to you or the minor reaches the age of 18 years. Patient Name Date of Birth Parent/Legal Guardian Signature Date Witness Signature Date Name SSN Date of Birth Relationship Work Cell Home Other Individuals Allowed to Accompany My Child. Without a signed consent form we cannot legally treat a minor child. the course of treatment photographs may be taken for clinical or educational purposes. If you are not the parent but are the legal guardian you will need to provide legal documentation that you are the legal guardian* This information will be kept in the child s file. If you are not the parent but are the legal guardian you will need to provide legal documentation that you are the legal guardian* This information will be kept in the child s file. Minor Accompanied by others If I am unable to accompany my child to the appointment the below listed individuals have my permission accompany my child. Minor Accompanied by others If I am unable to accompany my child to the appointment the below listed individuals have my permission accompany my child. This agreement is required in order for the unaccompanied child to be seen and treated* Initials CONSENT TO TREAT MINOR I authorize Tyler Oral Facial Surgery to treat and provide any healthcare services to my child that the provider deem necessary for treatment and/or diagnosis including biopsies. This agreement is required in order for the unaccompanied child to be seen and treated* Initials CONSENT TO TREAT MINOR I authorize Tyler Oral Facial Surgery to treat and provide any healthcare services to my child that the provider deem necessary for treatment and/or diagnosis including biopsies. I also understand in Unaccompanied Minors I grant permission to treat and provide any healthcare services to my child that the provider deems necessary for treatment if my child arrives at the office unaccompanied* Initials I further acknowledge this consent will remain in effect until either I revoke in writing and delivered to you or the minor reaches the age of 18 years.

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  1. Open the template in our feature-rich online editor by clicking on Get form.
  2. Fill in the requested boxes which are colored in yellow.
  3. Press the green arrow with the inscription Next to move from one field to another.
  4. Go to the e-autograph solution to e-sign the form.
  5. Add the relevant date.
  6. Read through the whole document to be sure that you have not skipped anything.
  7. Hit Done and save the resulting form.

Our platform allows you to take the entire procedure of executing legal documents online. Due to this, you save hours (if not days or weeks) and eliminate additional payments. From now on, fill in Facial Consent Forms from home, office, or even while on the move.

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Keywords relevant to Facial Consent Forms

  • deem
  • revoke
  • minors
  • guardians
  • physicians
  • documentation
  • provider
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