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AUTHORIZE TO CONSENT TO MEDICAL TREATMENT OF CHILD
Information of Child
____________________, male, born May 18, 2025 at ________________________ and residing at __________________________________________
Name: ____________________Address: ________________________Phone Number: ____________________Secondary Phone: ____________________Email: ____________________
Last Updated January 17, 2025
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A Child Medical Consent form is a document parents or guardians create to give another adult authority over their child’s medical treatment. It allows a temporary caregiver to make decisions for a child’s medical care if their parent or guardian isn’t available for any reason.
A Child Medical Consent form is also known as a:
Please note that LawDepot’s Child Medical Consent template is available for all provinces and territories except Quebec.
A Child Medical Consent form is an essential document for parents. It gives someone else medical authority if anything occurs in your absence. It does not revoke any of your parental rights. Instead, it ensures your child always has access to necessary medical care in case of emergencies or if your child has medical needs when you’re apart.
Examples of when to use a Child Medical Consent form can be when your minor child:
In most medical situations, doctors will only treat a child if a parent or guardian is present to consent to treatment. So, this consent allows a caregiver to consent on your behalf if you’re unavailable. The only exception may be in the case of an emergency, depending on the jurisdiction. For example, in Ontario’s Health Care Consent Act, doctors may perform emergency medical treatment if obtaining consent will prolong the severe suffering of the patient or cause bodily harm.
In Canada, children are often presumed mature enough to give medical consent at the age of 16, but medical personnel consider this on a case-by-case basis. Some provinces and territories have additional legislation on determining a child’s capability and age to consent to medical care.
For example, New Brunswick’s Medical Consent of Minors Act acknowledges that minors who are 16 years old may consent to medical treatment. Anyone under the age of 16 may also consent to medical treatment if they understand the nature and consequences of the treatment. They also must be able to make a decision that is in their best interest, continued health, and well-being.
In contrast, Alberta doesn't have additional legislation about determining a child's capability and age to consent to medical care.
When creating a Child Medical Consent, you can choose whether your child’s caregiver may consent to some or all routine and emergency medical treatments. Types of medical treatment could include:
You can also choose whether or not to give the caregiver access to your child's medical records, health insurance, or healthcare card.
Using LawDepot’s user-friendly questionnaire lets you create your Child Medical Consent form by completing the following steps:
Include the name and address of the temporary caregiver. If you like, there can be more than one person you give this authority to. Just be sure to include both their names and details on your form. Common choices for temporary caregivers include:
Provide your name(s) and address(es). Your consent form should include both parents, if applicable. If one parent has passed, or you have full custody, then you only need to complete and sign this section.
When you’re providing your child’s name, you’ll need to include a complete description of the following information:
Some optional details you can add to your consent form include:
Next, you need to outline what authority you’re giving your child’s temporary caregiver. You’ll need to consider the following questions:
Your consent will include diagnostic and surgical procedures, dental treatment, and blood transfusions unless you state otherwise on your form. Please list in detail anything you do not wish your temporary caregiver to authorize in your absence.
When you create your Child Medical Consent form, you can choose when the consent will start and decide if it will have a specific end date. For example, you can create a limited time of consent if your child travels without you by simply setting the day they return home as the end date.
If no end date is selected, your temporary caregiver can continue to have the authority until you revoke it with a written notice to them and any other parties that need to know, such as your family doctor.
Provide the signing date and the location where you’ll sign your consent form. If you wish to have it notarized, our template allows you to select that option for your final document.
Both parents or guardians, if applicable, should authorize the consent by signing the completed form.
There’s no legal requirement to have your Child Medical Consent form notarized. That being said, notarization is never a bad idea. It further validates your requests and authorization should a temporary caregiver need to provide medical consent for your child. Notarize your documents online from the comfort of work or home by connecting remotely to a notary with NotaryPro.
Alternatively, you can have two witnesses present when signing the document. In this case, your child’s nominated caregiver(s) cannot act as witnesses.
Sample
Child Medical Consent
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