Consent to Treat a Minor "*" indicates required fields Patient Full Name* First Last Your Email* Consent to Treat a Minor Policy (Please Read & Check Box)*I give the providers at Skin Health Forever Dermatology permission to treat my son /daughter / other in my absence. This includes permission to perform all medically necessary out-patient procedures including the prescribing of non-controlled medications excluding biopsies. My signature below indicates my understanding of this form and approval. This consent will remain in force for up to twelve (12) months from the date indicated below. I agree to the consent to treat a minor policy.Name of Parent / Legal Guardian* First Last Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
