Parental Consent to Treatment of Minor

Last Updated: July, 2023

I voluntarily consent to the diagnosis, medical care and treatment provided by First Opinion Health Services (FL) PLLC, First Opinion Health Services (IL), P.C., NY Medicine/Telemedicine, PLLC, First Opinion Health Services (NC), PLLC, First Opinion Health Services, Inc., First Opinion Health Services (TX), PLLC, First Opinion Health Services (GA), LLC, First Opinion Health Services NJ, LLC (“Curai Health”) that is considered necessary or recommended by my minor child’s physician(s) and other healthcare providers in their professional judgment.

I understand that there are risks and benefits associated with medical care and treatment provided to my child, including the provision of medical care through telehealth. I understand it is my responsibility to manage the login credentials for my child’s account on my mobile device and to be present for any pediatric encounter. I further understand that there is no certainty that benefits will be
achieved. I understand that reasonable alternatives to recommended care and treatment, if they exist, will be explained to me by my child’s physician or other healthcare provider. I understand that it is up to my child’s physician or other healthcare provider to determine whether or not specific clinical needs are appropriate for a telehealth encounter.

I understand that I will have the opportunity to ask questions about my child’s healthcare and treatment. I swear and affirm that I am my child’s parent or legal guardian with the right to make medical decisions about my child’s healthcare and there are no court orders preventing me from granting this consent to provide healthcare services to my child.