Dear Parent(s)/Guardian(s),

You have chosen to enroll your minor in the Freedom Clinic which is committed to the principles of healing and people's liberation from systems that make us unwell. We work to advance health justice, culturally appropriate care, and integrative medicine.

We want to be able to provide this care based on your wishes.

In order to do this, we need to know what your wishes are for when they are here without a guardian.

Note: By law, if a child shows up for care in the following situations they are allowed to consent for care and the provider can not give information about the visit or care to the parent without the child's permission. Of course, we feel family support is helpful and as such we will always encourage the child towards discussing all their concerns with their family.

*Reproductive care: Any age

*Mental Health care: 13 yrs or older

*All other care: 18 yrs and up

*The information above can not be shared with you without their permission.

Treatment the provider feels is necessary for the immediate safety of your child will immediately be commenced while we attempt to contact you regardless of your choices below.

Please check below to provide consent for your minor to access the following types of care from the Freedom Clinic. 

For all other cases, our policy is initiation of recommended treatment course that occur in the clinic that are non-urgent will only be done after speaking with you if it is not one you have consented to above.

The provider will attempt to contact you if there appears to be a need to change the treatment plan. Please, of course, feel free to contact us at 206.299.1812 or freedomclinic@myrvla.org if you have any questions or concerns. If in the future you wish to change or revoke this consent to treatment in your absence, please notify us and we will help you get the request in writing.