Physical Therapy Consent for Minor | Sarasota Physical Therapy

Donna Mathisen Barcomb Professional physical therapy

CONSENT FOR TREATMENT OF A MINOR CHILD

I hereby authorize Donna Mathisen Barcomb, MS, PT and whomever she may designate as her assistants to administer Physical Therapy as she deems necessary to my

Relationship to Child

Child’s Name

City

State

Date

Parent/Guardian Signature

Witness Signature

Donna Mathisen Barcomb Professional physical therapy

CONSENT FOR TREATMENT OF A MINOR CHILD

Quick links

Contact Us