Open this document
Open the form to review it in your browser, print it, or download a copy when that option is available.
Save your work. After completing the PDF, save or download a copy before closing your browser or PDF viewer.
Forms & Documents
Consent for Minor Use of Software Services
Parent or guardian consent for a minor to use approved scheduling, messaging, telehealth, document, or client-portal software connected to care.
Using this form
Complete the fillable fields and save a copy, then print and sign by hand. Use one of the return options below.
After you complete this form
How to return this form
Return onlineUse your secure Client Portal when the practice has asked you to return this form online. If this form was assigned in your Client Portal, complete that version there.
Open Client Portal- Bring the completed form with you when you visit the practice.
Please don’t email completed forms. Use one of the return options above.