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Free Child Medical Consent Form

Child medical consent allows parents and legal guardians to grant authority over their child’s healthcare decisions to a caregiver. Create your own printable, free child medical consent form now.

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Last Update May 18th, 2023


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Child Medical Consent FAQs

There are many important considerations to be mindful of when creating a child medical consent form. Use our selection of FAQs below to get to grips with the requirements of these essential legal documents.

Where to Find a Child Medical Consent Form?

Child medical consent forms can be found and completed online. Our own pre-prepared template and guidance instructions can help you through each step of the process.

This will help you avoid common mistakes and include the essential information needed for this kind of document. Once the form is completed it just needs to be printed off, signed (in the presence of two witnesses), and notarized.

When Is it Necessary to Notarize a Child Medical Consent?

Yes, a child medical consent form must be witnessed (by two witnesses) and also notarized. This is a crucial step when putting your document into effect properly.

To sign the form correctly, the parents signing the form must gather their witnesses and write their signatures on the form in the presence of a notary public.

This is so the identities of the parents can be correctly verified and to ensure that no court orders have been taken out against the parent or guardian signing the document.

How to Choose a Temporary Guardian for a Child Medical Consent?

The most important consideration when completing a child medical consent form is choosing a caregiver you trust. They must be over 18 years old, they should demonstrate a clear concern for the wellbeing of your child, and ideally should align with your moral beliefs and healthcare choices.

What Is The Difference Between a Child Medical Consent Form and a Child Travel Consent Form?

Child medical consent forms and child travel consent forms are both important documents when granting parental consent to a caregiver. However, they are quite different in their individual uses.

A child medical consent form may only be used to permit caregivers to make medical decisions for a minor. Travel consent forms on the other hand are used to allow a child to travel alone or with someone who is not their parent or guardian.

In many cases, however, both forms may be required if a child is to travel across states or internationally without their primary caregiver.

How Can I End the Authority of The Temporary Caregiver?

In most states, child medical consent forms include an expiry date, which will usually be 6-12 months after the document is signed. When this time is reached, the temporary caregiver will no longer have any authority to make medical decisions for the child in their care.

Also, in the majority of states, medical services and healthcare organizations will not accept consent forms that are indefinite in basis. This is because they are not seen to be valid or enforceable as ongoing guardianship can only be approved by the courts.

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First Child's Information

Child's Full Name: _________
Gender: Male
Date of Birth: _________
Place of Birth: _________
Address: _________
Parent/Legal Guardian Information
I, _________, parent or legal guardian of _________ do hereby swear and declare that I am the parent or the legal guardian of the child/children herein listed and that there are no court orders preventing the parent or guardian from granting this authorization.
In case of an emergency, the parent(s) or legal guardian(s) should be contacted at the following:

Name: _________
Address: _________
Phone Number: _________
Secondary Phone: _________
Email: _________
Caregiver Details and Consent Information
I name and authorize the following as my Caregiver(s):

_________ residing at _________.

The parent(s) or legal guardian(s) authorize the Caregiver(s) to obtain and consent to any Emergency Medical Care and Treatment, including hospitalization, anesthesia, surgery, and blood transfusion.

The parent(s) or legal guardian(s) authorize the Caregiver(s) to obtain and consent to any Routine Medical Care and Treatment, including Dental Care, and Treatment.
I DO NOT authorize the Caregiver(s) to have access to any medical information.
Consent Details

This granting of authority will be effective on _________.
I agree that this is an informed consent, given freely and with certain knowledge of its purpose, in order to provide medical care for the child/children.
The authority granted under this Child Medical Consent form may be terminated through a written notification addressed to the Caregiver(s) named above and to the child/children's medical and insurance providers, stating that I wish to revoke it.
Witnessed Signature

IN WITNESS WHEREOF, I hereunto sign my name at _________, Alabama this ________________ day of ____________, ________.


Witness: __________________________

Print Name: _______________________

Witness: __________________________

Print Name: _______________________
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