Free Parental Medical Consent Letter Template
Parental Medical Consent Letter
December 5, 2050
To Whom It May Concern,
I, [Your Name], am the legal parent/guardian of [Child’s Full Name], born on [Child’s Date of Birth]. I hereby give my full consent and authorization to [Authorized Person’s Full Name] to seek and obtain medical care and treatment for my child in case of illness, injury, or any medical emergency.
This authorization covers the following:
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Medical examinations and diagnostic tests.
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Administration of medications and necessary treatments.
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Hospital admission, surgical procedures, and emergency medical interventions as deemed necessary by medical professionals.
Child’s Information:
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Full Name: [Child’s Full Name]
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Date of Birth: [DD/MM/YYYY]
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Address: [Child’s Full Address]
Authorized Person’s Information:
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Full Name: [Authorized Person’s Full Name]
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Relationship to Child: [Relationship, e.g., Grandparent, Teacher, etc.]
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Contact Number: [Authorized Person’s Phone Number]
Parent/Guardian Information:
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Full Name: [Your Name]
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Relationship to Child: Parent/Guardian
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Address: [Your Address]
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Contact Number: [Your Phone Number]
This consent is valid from [Start Date] to [End Date] unless revoked in writing earlier.
In case of an emergency, I can be reached at the contact details provided above.
Sincerely,
[Your Name]
