Medical Consent Form
A medical consent form is a document that ensures ones children receive immediate medical attention in an emergency situation when the children are away from their parents. A medical consent form serves to avoid delays in situations by providing vital information about the child’s health condition such as allergies.
Sample Medical Consent Form
In case of emergency, ____________________________has my consent to authorize medical care for my children listed below:
Our family doctor is: ___________________________________
His/her address is: _______________________________________
His/her telephone # is: ____________________________________
Our hospital preference is: _________________________________
Allergies: _______________________________________________
Contact me immediately at: ———————————————————————-
If unable to contact me, please call:
____________________________ at_________________________
Name Telephone
____________________________at_________________________
Name Telephone
Signed by
Name: _________________________________________________
Address: _______________________________________________
Telephone: _____________________________________________
Date: ________________________
Notes:
Category: Medical Forms
