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Patient Registration and Patient Agreement with MVP Pediatric and Urgent Care - For Established Patients |
Demographic Information
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Please complete the following information, so that we can expedite your registration. Thank you!
I voluntarily present to MVP Pediatric and Urgent Care and consent to treatment by the physician on duty and whomever they may designate as their assistant, associate, treating physician and patient care staff to provide my child’s care or myself (if I am the patient and older than 18 years of age). Such care may include, but is not limited to, diagnostic procedures, radiological evaluations and procedures, and the administration of medications considered advisable in my child’s or my diagnosis, treatment, and course of care. I acknowledge that no guarantee can be made or has been made as to the results of treatments or examinations and I understand that all medical treatments contain inherent risks