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Guardian's full nameYou are the child's

Mobile numberEmailHome addressPasswordI consent to Treehouse Pediatrics collecting and processing my child's personal and health information for consultation, treatment, billing and record-keeping, in accordance with Republic Act 10173 (Data Privacy Act of 2012). I may access, correct or request deletion of this data at any time.

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Patient information is handled under RA 10173 (Data Privacy Act of 2012).