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Home | North American Programs | North American Clinics | Recipient Participation Forms

Recipient Participation Forms

Thanks for your help in coordinating your students' visit to our clinic. Prior to their visit, please be sure to download the following two forms to be completed by each patient's parent or guardian. These forms must be completed prior to their attending our clinic.

Parent or Guardian Consent Form:

Parent or Guardian Letter:

HIPPA Forms:




Consent form - English (80.0 KB)

Letter - English (57.6 KB)

Consent Form - French (37.1 KB)

Letter - French (40.3 KB)

HIPPA - Spanish (224.0 KB)

HIPPA - English (203.8 KB)

Consent Form - Arabic (46.0 KB)

Consent Form - Polish (63.6 KB)

Consent Form - Simplified Chinese (283.9 KB)

Letter - Simplified Chinese (153.7 KB)

Consent Form - Spanish (19.8 KB)

Letter - Spanish (60.7 KB)

Consent Form - Traditional Chinese (280.8 KB)

Letter -Traditional Chinese (149.8 KB)

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