Permission to Treat (Newborn to 17 years) | Pediatricians in Tampa Bay | Offices in Hillsborough, Pasco, and Pinellas

Nights-Wknds

Telemedicine

Patient Portal

Bill Pay

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

Telemedicine

Patient Portal

Online Bill Pay

Permission to Treat (Newborn to 17 years)

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 provide medical care to your child if they are not accompanied by the parent(s)/legal guardian listed on the Patient Registration Form.