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Permission to Treat Minor Form

We perform the Ohio Department of Job and Family Services Employee physical using this form*.

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

Hours of Operation

Monday – Friday
10:00 am – 6:00 pm
9:00 am – 3:00 pm
10:00 am – 3:00 pm

We are a walk in clinic and do not require appointments, however we must limit the number of patients so that we may close on time and in accordance with the host stores. Please call and speak with the Front Desk to check availability.

Treatments and Costs

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.

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