Patient Resources

Consent for Treatment of Minor

For your convenience we provide our patient forms online. If you are the parent of a minor and would like your child to be seen by any of our providers without your presence, please print and fill out the below form and have your child bring it to the appointment. Forms can be filled out in your browser via Adobe Reader or Acrobat, depending on browser type. Note that Adobe Reader cannot save typed data and we suggest printing copies for your records.

You will need Adobe Reader to view and print these forms. If you do not have it you can download it for free from Adobe. Click on the link below.



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*By using this form to communicate with austin Regional clinic (ARC), the information will be transferred over the internet. ARC uses Transport Layer Security (TLS) encryption in order to secure the information you send to us over the internet. There may be times when we cannot respond to your request in email format and another method of communication will be used. For your privacy, please consider the information you include, and who, besides you, may have access to your email account.

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