Agreement and Electronic Signature
I have read all of the above and acknowledge that it is true and correct. In case of an emergency, I understand that every effort will be made to contact the people I requested. I understand that 911 will be contacted first should the situation warrant such action. I give permission for my child to obtain medical or surgical care from North Colorado Medical Center, physicians or dentists should the need arise. I understand that all possible efforts will be made to contact me before such action is taken. If it is not possible, treatment as deemed necessary by the physicians may be taken. I authorize direct billing to my insurance and am financially responsible for the charges not covered.