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Please check one that applies Patient is a minor living with both natural parents both parents share legal decisions Custodial Parent s Name Print court order is required on file with Orthodontist parents share equally in legal decisions grandparent does NOT have legal guardianship Grandparent s Name Print Name of legal guardian Print grandparent HAS legal guardianship court order is required Print Custodial Person s Name person child is living with Print Legal/Financial Person s Name CONSENT...
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