Permission to Treat

If you’d like to authorize another adult to consent for treatment of your child in your absence, please fill out the Permission to Treat form.  Fax the completed form to us at (469) 671-5437.

If you need to release records for an adult child, please have the patient fill out this Adult Authorization.  The  patient should fax the signed form to us for placement in the permanent record.

"Quick and courteous service, very efficient! Thank you!!! Been with MD Pediatrics since 2006 and have always had a good visit with their wonderful staff!!"

- Harrison B.

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