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Available Forms

RAPID TEST ONLY- Patient Intake

Patient Information

Last, First
only number that will receive reminders

Patient Guardian info (if patient is a minor)

Additional Info

I understand I am not establishing a physician/patient relationship with Ideal Pediatrics. This consent is for testing and results only. If I desire any medical advice from the testing results, I understand I must contact my own primary care provider or health department.

* Required field