Permission to treat a Minor: Hillside Family Medicine must receive permission from a child’s
parent or legal guardian before providing treatments for an injury or
illness that is non-life threatening. This form gives us legal
permission to treat your child in case you cannot accompany him/her to
the clinic for treatment. If the party accompanying your child
(baby-sitter, friend, relative, etc.) does not present this information
the clinic will attempt to contact you to request permission to treat your child.
