I authorize Perimeter West Eye Care to provide eye care to my son/daughter, including, but not limited to, diagnostic examinations, measurement of ocular pressure, dilation of pupils, and if requested, contact lens fitting and evaluation, and necessary treatment for eye injury or disease as deemed appropriate by his/her optometrist.
This consent will remain in effect indefinitely until the patient reaches the age of eighteen, unless revoked in writing to Perimeter West Eye Care.
By signing below, I acknowledge that I have read and agree to this consent.