Before any student is seen at the School-Based Telehealth Site ("Telehealth Clinic"), a signed consent form must be on file. In addition to the consent on file, the parent/guardian will be contacted before each visit to receive verbal consent for the child to be seen. Please check the appropriate box below regarding verbal consent.
All’s Children Pediatrics may, depending on the diagnosis, prescribe medication to students seen at the Telehealth Site. In the event that the Telehealth Site physician prescribes medication, they will make every effort to contact the student's primary care provider (identified in the Enrollment Packet). Such a contact requires the consent of the student's parent or guardian. Please check the appropriate box below regarding contacting your child's primary care provider.
I, the undersigned,
I have had the opportunity to read this form and the information provided. All my questions have been answered to my satisfaction.