Parental Consent to Treat
Parental Consent for Medical Services to Minors

By signing this consent, I authorize Lighthouse Pediatrics of Naples to provide medical services without my presence to the minor child/children listed below:



 



I am listing the names of the people that I have given permission to bring my child/children to the medical office in my absence.



 



This consent pertains only to the minors listed above. Each person who will bring the child/children to the medical ooffice is required to bring picture ID for identificatioono verification.

I understand that I am accepting financial responsibility for all medical services rendered for the patients and that payemnt is due at the time of service. I have the right to revoke this consent in writing



 



Contact Us

If you are an established patient, please use the portal.  Click below to go to the portal website:  If you are not already registered for the portal, you may call the office to sign-up.

Lighthouse Pediatrics Portal

You may use the form below to request NON-urgent appointments.  Please do not include personal health information.

Our Location

Office Hours
Monday:8:30 AM - 5:00 PM
Tuesday:8:30 AM - 5:00 PM
Wednesday:8:30 AM - 5:00 PM
Thursday:8:30 AM - 5:00 PM
Friday:8:30 AM - 5:00 PM
Saturday:Closed
Sunday:Closed