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Ketchum Health 5460 E. La Palma Ave Anaheim CA 92807 CONSENT FORM FOR TREATMENT OF MINORS The undersigned parent/legal guardian of does hereby Name of minor and age empower and grant to Name phone number the right to consent permission of any examination medical diagnosis tests treatment including dilation to be rendered for my child/ward. This authorization shall be valid for the visit commencing on and ending. I do hereby indemnify and hold harmless the Eye Care Center and any optometrist...
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