If you are the Parent or Guardian of a minor and you’d like to authorize another adult to Consent to Treatment for your minor, please follow the steps below before scheduling a visit. Thank you!
Download the Parental Delegation of Consent Form
Print the document and fill out each field. Add your signature and scan in or take a photo of your completed copy. Note: For this form, an electronic signature is not sufficient.
Send your completed form to firstname.lastname@example.org. We’ll review the form and update the patient chart to indicate another adult has been authorized to accompany them to their visit.
Feel free to schedule a visit at zoomcare.com or using the Mobile App.
If you have questions about the form or would like to ensure it’s been received prior to scheduling, please contact our Help Team at 503-684-8252 for assistance.