Non Medical consent form

---

Used for Over the counter products Sunscreen, topical ointments, lotions, creams, sprays, bug spray, etc. 

Must be completed by a Licensed Authorized Prescriber. Prescription medications, oral over the counter medications, medicated patches, eye, ears, or nasal drops or sprays, etc

MUST BE COMPLETED BY LICENSED PHYSICIAN, PA (PHYSICIAN ASSISTANT) OR NURSE PRACTITIONER