Minor Treatment Consent Form

The Minor Treatment Consent Form provides the legal authorization required to treat patients under the age of 18. It captures the parent or legal guardian's consent for medical examination and treatment, including emergency medical care authorization in the event the guardian cannot be reached.

The form documents the relationship between the consenting adult and the minor patient, verifying legal authority to provide consent. It covers routine medical care, emergency treatment authorization, and specific procedure consent when applicable. Designated responsible adults are listed with contact information for situations where the guardian is not present -- such as grandparents, babysitters, or family friends who may bring the child to appointments.

Additional sections cover immunization consent, prescription medication authorization, and any treatment restrictions the guardian wishes to specify (e.g., religious objections to blood products, allergy concerns). This form is essential for pediatric practices, school health clinics, summer camps, daycare medical authorizations, and any healthcare setting that treats minors. It provides legal protection for providers while ensuring that guardians maintain appropriate oversight of their child's care.