Below is a sample letter for medical consent. It should be written in formal business-letter style and notarized or witnessed if required. The original can be given to the temporary caregiver, and a copy should be kept by the legal guardian.
Sample Letter for Medical Consent
Name of Legal Guardian
Address of Legal Guardian
City, State, Zip Code
RE: Medical Consent
To Whom It May Concern:
I, Name of Legal Guardian, am the lawful guardian of the female child named below. I give permission and consent to Name, Address and Phone Number of Temporary Caregiver to authorize medical treatment for Full Name of Child and date of birth. This permission is granted from DATE and will expire on DATE.
Signature Of Legal Guardian DATE
Printed Name of Legal Guardian
Signature of Witness or Notary (if required by the state) DATE
Printed Name of Witness
By Andre Bradley