Free Printable Child Medical Consent Form (Word / PDF)

A child medical consent form is a written document used by parents or legal guardians to authorize another individual to make healthcare decisions for their children. They may grant authority to a grandparent, aunt, uncle, or family friend. Some alternative names for this form are;

  • Emergency medical consent form
  • Minor medical consent form
  • Caregiver consent form
  • Parental medical consent form
  • Medical treatment authorization form
  • Child medical release form

When do you need a child medical consent form?

Parents can use this form to authorize medical treatments for their minor children whenever they are away from them. You have to give parental consent if your child isn’t old enough to consent to medical treatments. Furthermore, the caregivers or healthcare professionals may face legal consequences if they act without proper consent.

Who can use a medical consent form?

A child medical consent form can be used by parents and legal guardians to grant authority to temporary caregivers. These may include;

  • Grandparents or other family members
  • Daycare and childcare providers
  • Sports team coaches
  • Teachers
  • Babysitters
  • Nannies

In addition, it is safe to create a child’s medical consent if parents are traveling without their child or if the child is traveling without their parents.

What to include in a child medical consent form?

Include the following basic elements in a child’s medical consent;

  • Name and contact details of the parents or legal guardians
  • Each minor’s name, address, and date of birth
  • Name of caregiver (who is responsible for making medical decisions for the children)
  • Child’s medical history (health condition, allergies, and vaccines)
  • Details of healthcare provider
  • Health insurance details
  • Parents or legal guardians signatures

Writing a child medical consent form:

Consider the following steps to write this form;

Provide basic details of the child

This section of the form should provide the following details about the child;

  • Full name
  • Sex
  • Date of birth
  • Age
  • Address

Include consent-giver information

Here, you will specify who will give consent and sign the form. Both parents should sign the form if they are available. However, the signature of one parent is also sufficient. Also, provide the name of the consenting adult and the relationship to the child.

If a legal guardian is a consent giver then attach guardianship papers or a court order to your form. Provide the complete name and contact details of the parent or legal guardian who is giving consent.

State the medical treatment

In your child’s treatment, you can select the range of medical care. Grant authorization to the caregiver to decide on specific types of medical care such as routine examinations and checkups, emergency medical treatment, medication administration, and more.

Give health background

This section enables the medical and healthcare professionals to make quick and effective decisions. Make this section as detailed as possible. Include the following details;

  • Primary doctor
  • Primary dentist
  • Preferred medical facility
  • Insurance information

Sign the document

When it comes to signing the document, affix the signatures of witnesses or have the form notarized in front of a notary public. Including witnesses or notary acknowledgment may vary by state.

Consent to Treat Minor Children

consent to treat minor children
File Format
Size: (16 KB)

Medical Consent Form for Minor

medical consent form for minor
File Format
Word (doc, docx)
Size: (18 KB)

Authorize to Consent to Medical Treatment of Child

authorize to consent to medical treatment of child
File Format
Word (doc, docx)
Size: (16 KB)

Medical Treatment Authorization and Consent Form

medical treatment authorization and consent form
File Format
Word (doc, docx)
Size: (16 KB)

Authorization to Consent to Medical/Dental Care of Minor

authorization to consent to medical and dental care of minor
File Format
Word (doc, docx)
Size: (16 KB)

Consent for Non-Parent to Bring Minor Child to Appointment

consent for non parent to bring minor child to appointment
File Format
Word (doc, docx)
Size: (14 KB)

Printable Child Medical Consent Form

printable child medical consent form
File Format
Word (doc, docx)
Size: (23 KB)

Parental Consent Form for Minor Child to Travel

parental consent form for minor child to travel
File Format
Word (doc, docx)
Size: (12 KB)

First Aid and Emergency Medical Care Consent Form

first aid and emergency medical care consent form
File Format
Word (doc, docx)
Size: (15 KB)


How to end the authority of the temporary caregiver?

The child’s medical consent form must include an expiry date. The temporary caregiver will no longer have any authority when this time is reached. It will usually end in 6-12 months after the document is signed.

How to select a caregiver for a child’s medical consent?

For a child’s medical consent, you should select a caregiver who is over 18 years old and aligned with your moral beliefs and healthcare choices.

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