Free Child Medical Consent

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Create Your Free Child Medical Consent

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Child Medical Consent

Effective Date

Effective Date

When will this consent be valid?

Frequently Asked Questions
What is the start date?The start date is the date which the consent becomes effective and the temporary caregiver can begin to make medical decisions on behalf of the child.What is the end date?The end date is the date which the consent expires and the temporary caregiver will no longer have the power to make medical decisions on behalf of the child. If no end date is selected, the temporary caregiver will continue to have power indefinitely until the parent/guardian revokes it with a written notice to the proper parties.How do I end the authority of the temporary caregiver if I don't specify an end date?The parent/guardian may end the consent at any time by notifying the child's medical and insurance providers in writing that they wish to revoke the consent granted to the temporary caregiver.

Your Child Medical Consent

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  1. I, ____________________ of ________________________ make oath and say that I am the lawful guardian of the child listed below and there are no court orders now in effect that would prohibit me from conferring the power to consent upon another person.

    Information of Child

    ____________________, male, born 15 July 2024 at ________________________ and residing at ________________________

  2. I hereby authorise and appoint ____________________ of __________________________________________ as my agent (my "Agent"). My Agent may consent to my child's
    1. transportation by ambulance;
    2. examination;
    3. x-rays;
    4. diagnoses;
    5. hospitalisation;
    6. anaesthesia;
    7. medication.

    I do not authorise ____________________ to consent to the transfusion of blood.

  3. My Agent may have access to any and all records, including, but not limited to, insurance records regarding any medical services or treatment provided.
  4. The purpose of this instrument is to give ____________________ the power and authority to consent to medical treatment for my child. This power and authority will be effective as of the 15th day of July, 2024.
  5. I give this consent freely and knowingly in order to provide for the child and not as a result of coercion, duress or payments by any person or agency.
  6. This consent will remain in effect until it is revoked by notifying my child's medical, mental health care and insurance providers, in writing, and the Agent named above that I wish to revoke it.
  7. Any questions or concerns regarding this authorisation may be directed to me at:

    Name: ____________________
    Address: ________________________
    Phone Number: ____________________
    Secondary Phone: ____________________
    Email: ____________________

IN WITNESS WHEREOF, I hereunto sign my name at ____________________, Andaman and Nicobar Islands this ________ day of ________________, ________.




The instrument was acknowledged before me on the ________ day of ________________, ________, by ____________________.

Being satisfied as to the identity of this executant, I hereby subscribe my hand and seal at ____________________________ on this ________ day of ________________, ________.

Notary Public

Last updated March 27, 2024

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Parents and legal guardians use a Child Medical Consent form to give another person the authority to make medical decisions for their children.

In addition to personal details about the child, their legal guardians, and their temporary caregiver, a Child Medical Consent form typically includes the following:

  • The child’s health history (e.g., conditions, illnesses, allergies, and medications)
  • Contact info for a family doctor and an emergency contact person
  • Health insurance coverage
  • The emergency and routine medical treatments that the legal guardians consent to
  • Whether the caregiver can access medical information or insurance records

The form also specifies when the caregiver’s authority begins and, typically, when it ends.

You can customise LawDepot’s Child Medical Consent template to align with your child’s situation and needs. Simply answer a set of questions, then download the form as a PDF or print a hard copy.

It’s important to use a Child Medical Consent form to authorise medical treatments for your minor child when you’re not there.

For instance, your child may need routine treatments (e.g., asthma inhaler) while at daycare or school. Or, they may travel with a sports team or school group and need emergency treatments after an accident.

In any case, if your child isn’t old enough to consent to medical treatments, you’ll likely need to give parental consent.

If caregivers or healthcare professionals act without proper consent, they may face legal consequences (although, there may be exceptions in emergency situations).

Alternatively, your child’s condition could worsen or cause them physical pain while healthcare workers wait for permission to act.

Good news: a Child Medical Consent form helps prevent these situations.

Why should parents make medical decisions for their child?

Parents are responsible for the well-being of their children. Consenting (or refusing consent) to healthcare is a large part of maintaining a child’s quality of life.

Of course, when your kids are old enough to understand, you can allow them to participate in medical decisions by:

  • Explaining how treatments work, their benefits, and potential side effects
  • Allowing them to ask questions
  • Asking for their input
  • Respecting their feelings

The legal age for a child to consent to medical care in India is 18. However, children aged 12 to 18 can consent to medical exams (not treatments) without parental consent. Children in this age group can assent (i.e., agree) to treatments, although laws prohibit them from giving legal consent. 

Although hospitals and other health organisations may have their own policies on parental consent, typically only one parent needs to give permission.

However, if the parents are separated or divorced, they may have an agreement or a court-order in which they specify which parent is in charge of making healthcare decisions. This parent might have sole custody of the child, although the other parent may see the child regularly.

If parents have joint custody, either parent can consent to treatments.

Parents and legal guardians can use a Child Medical Consent form to grant authority to their child’s temporary caregivers, including:

  • Grandparents or other family members
  • Teachers
  • Childcare providers
  • Sports team coaches
  • Babysitters
  • Nannies

In most cases, it’s ideal to notarize a Medical Consent form because it helps ensure your document is legally valid.

A notary public:

  • Verifies the identity of the signing parties
  • Ensures the parties understand the agreement
  • Puts their official stamp or seal on the document

If you don’t plan to notarize your document, LawDepot’s Medical Consent template will have a space for two witnesses to sign. A witness should be an independent third party who has no ties to the parent or child. A temporary caregiver should not be a witness.

Related documents

  • Child Travel Consent: Give a minor the permission to travel with one parent, someone who isn’t their legal guardian, or alone.
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Child Medical Consent

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