Permission to Treat | Pediatricians in Tampa Bay | Offices in Hillsborough, Pasco, and Pinellas

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We are the one place you can bring your child
for all of your child's medical needs.
Your Child's Medical Home™

Nights-Wknds

Insurance

Patient Portal

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Permission to Treat

Please complete this form to notify us as to the individuals who may bring your child to the office for treatment. Without this form, we will be unable able to deliver medical service to your child if he or she is accompanied by someone other than the listed parent(s)/legal guardian.

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