Consent to Emergency Medical, Dental or Surgical Treatment of a Minor
I hereby consent to any medical, dental, or surgical treatment or procedure of an emergency nature that is reasonably necessary to save the life of the minor named above or to restore the child to health, including emergency transportation to a medical facility if deemed necessary.
I understand that should medical emergency treatment be required, the current insurance information listed here will be provided to the attending clinic or hospital to cover future payment of incurred bills.