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. If unable to reach you the appointment may be rescheduled. Thank You.
Personal Health Information Release (PHI): This release is not required but if you would like someone other than yourself to have access to your medical records such as a spouse or parent please complete this release. This release does have some restrictions, see form for details.
Please fill out the following forms if requested/relevant: