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I would like to request a Remote Second Opinion or Consult through the website.

I have discussed this request with my child’s physician and understand the risks and limitations of this service.

I also understand that if I reside in a state that is not in the state of the physician providing the Second Opinion or Consult, that I must provide my child’s primary care or treating physician information. I acknowledge that this physician is a licensed physician in the state in which my his/her practice is located AND is a licensed physician in the state which I reside, so that the opinions can be shared with him/her and then further shared with me.

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