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Permission to Treat Minor Form

*PLEASE NOTE: All required vaccination records must be presented at the time of the visit in order to complete the physical.

***WE ARE CLOSED DURING REMODELING***

We encourage calling first and make an appointment to avoid possible long wait times. This will also allow our staff to better prepare.

Wadsworth: 330.336.3588 Option 15, Option 0

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In order to expedite your visit, please click below and complete your office registration. This will only take a few minutes but will save valuable time during your visit.
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Covid testing now available.
BY APPOINTMENT ONLY
Call for your appointment:
Wadsworth: 330.336.3588 Option 15, Option 0

Minor Injuries

Minor Illnesses

Age requirement is 2 years and above…

Family Statcare requires all patients 18 and under to be accompanied by an adult. If the parent/guardian cannot be present, this consent to treat form must be completed by parent/guardian with permission for another adult to bring child in. This form is required to be seen and must be presented at the time of service.

PREPARTICIPATION PHYSICAL EVALUATION FORMS | Ohio High School Athletic Association – 2023-2024