Your child has been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity
Disorder (ADHD). Medications used for the treatment of ADD/ADHD are classified as stimulants and are
regulated by state and federal law. Your understanding and cooperation with the following guidelines are
required for your child to receive medication for the treatment of their ADD/ADHD at M. T. Curry Pediatrics.
Please initial next to each point and provide your signature to indicate your understanding and agreement to the terms of this contract. Please note, if there is more than one legal guardian, both individuals will be required to initial and sign this agreement prior to treatment beginning.
First & Last
Please type your full name indicating your agreement with the terms above.
Please type your full name indicating your agreement with the terms above. <br/><br/>Type N/A if there is only one legal guardian (we must have custody forms on file for this to be accepted)
Type N/A if not applicable