17 answers

Consent for Medical Treatment Form

I need a form that would allow my parents to provide treatment for my girls if something happened while in there care. We are leaving for 2 days and going about 4.5 hours away. I can't seem to find one on the web. Does anyone know where I can get one?

What can I do next?

So What Happened?™

Thank you all so much for responding!! I will print out the forms provided but also have one drawn up with a notary to make it official. Thanks for the advice!

Featured Answers

I have a form if you would like me to fax it to you or you can pick it up. I live in Cypress and have a daycare so my daycare parents had to fill one out.


More Answers

You don't really need a "form" -- just write/type up a consent and sign and date it (that's what my husband and I did for our babysitter and she was in the medical field for 14 years).

We have just written a simple letter which our doctor approved of which states:

To Whom It May Concern:

I hereby authorize ..... residing at ...... as my proxy and grant him/her the authority to make decisions regarding the medical care of my son ..... and daughter ...... from ..... to ......


Hi, Have you called your doctor? I had to get one for my daycare provider and I got it from my son's doctor's office.

This is what i use when we are leaving out of town...
hope that helps!

Hi K., all you need to do is write a letter of consent that says,

I K. so & so give my parents ( their name ) persmission to seek any medical care for my daughter ( name ) while she is visiting or traveling with them. In the case that either parent ( both names of parents ) and all attempts to reach my daughters parents I give permission for my parents ( name )
to consent to medical treatment to stablize her condition, until ( daughters name ) parents can be notified.

sign both parents __________ date it from the time she is with them until the time she returns.

Your medical insurance info
your doctors name, and address
your daughters SS #

An discription of any medical conditions she might suffer from now, list any medications she is on.

Your parents name address

list in case of emergency number other than you in case they can't reach you ,

I been using this for years my duahgter visits her aunt every summer, it is a legal note.

hope this helps
T Miles

I have always used a hand written letter, which included where I could be reached at all times, and instructions that my parents could seek any medical care they deemed necessary in my absence for my children. I believe you could also use a medical power of attorney for the same purpose when your children are not in your care and if you could not be reached by phone and drs. would honor that as well.

I've never had to have an actual consent form. I typed up a letter of consent for each one of my kids to get treatment when in the care of my parents. I have never had a problem. Just a letter saying you give permission for your parents to make any medical attention reguarding your children. Then sign it. It has worked for me. I have never actually seen a form for that before.
W. E.

What my parents did and the parents of the children I have nannied did was to write a formal letter. In the letter they stated that the person (in this case your parents) has your permission to make medical decisions for your children in your absence, stating the dates. You can have a notary put a seal on it to make it legal. I am not sure that that is necessary, as in California a written agreement is considered legal if both parties sign and agree to the terms. If you have a friend or family member who is a lawyer check with them to be sure. In the letter also state the children's doctor and contact info. as well as dentist, etc. Then give copies of the letter to the school, daycare, doctors, etc. as well as your parents. good luck!

1 / 3
Required Fields

Our records show that we already have a Mamapedia or Mamasource account created for you under the email address you entered.

Please enter your Mamapedia or Mamasource password to continue signing in.

Required Fields

, you’re almost done...

Since this is the first time you are logging in to Mamapedia with Facebook Connect, please provide the following information so you can participate in the Mamapedia community.

As a member, you’ll receive optional email newsletters and community updates sent to you from Mamapedia, and your email address will never be shared with third parties.

By clicking "Continue to Mamapedia", I agree to the Mamapedia Terms & Conditions and Privacy Policy.