262-717-9104 office@vistawi.com

Temporary Guardian Form

Dr. V and Dr. Megan REQUIRE a parent/guardian to accompany a minor to their FIRST dental visit at Vista Family Dentistry. After the initial visit, Dr. V and Dr. Megan recommend and prefer that a parent/guardian accompany a minor, but understand that situations may arise that make it difficult or impractical to accompany a child to every visit.

If you are unable to bring and/or accompany your minor child to their dental appointments, please call our staff in advance and complete/use the Temporary Guardian Form below to authorize someone to accompany your child and consent to their treatment needs on your behalf.

Temporary Guardian Form

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