Test Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.File Upload Click or drag a file to this area to upload. CheckboxesFirst ChoicePermission is hereby given for any medical/surgical procedure, X-rays, drug or laboratory test, medication, or exam as may be deemed necessary by the Psychiatrist, Physician Assistant, or Nurse Practitioner. I understand I have the right to see a psychiatrist if I choose and have the right to see a psychiatrist prior to any prescription drug or device order being carried out by an Advanced Practitioner. In the case of an unemancipated minor, the consent below is being given on his or her behalf.Submit