Medical Release Form for Consent to Treat Your Kids

Emergencies happen and you may not be available to give permission

Young girl with broken wrist
asiseeit/Getty Images

Most of the time, kids' accidents and emergencies are entirely unpredictable and unexpected. Of course you don't plan on your child falling and breaking a bone while he's with a babysitter, or needing emergency care for an allergic reaction when he's staying with grandma. These incidents catch caregivers off guard, too! That's why you need to provide a medical release form to anyone caring for your child in your absence. This simple form gives clear, irrefutable consent for medical treatment.

If you cannot be reached by phone, text, or email, the form can be used in the event that your child suffers an injury that requires medical treatment. It is one of the most important steps any parent can take to ensure your children are safe, even when you're not around.

Why You Need a Medical Release Form

Hospitals have to treat everyone who comes through the door, right? That isn't necessarily true, especially when it comes to children. Many urgent care facilities and emergency rooms will not treat minor children unless:

  • A parent is present
  • A parent has given consent in writing
  • The child's life is in danger

That means that injuries or illnesses that aren't life-threatening may not be treated. Say your son suffers a broken bone on the playground while you're at work or out of town. You don't want him to have to wait for treatment—including pain relievers—until you can be reached. 

Printable Permission to Treat Form

The St. Louis Children's Hospital has a free "Permission to Treat" form that you can download and print. It is a simple, one-page document that includes all of the relevant information caregivers and medical staff need to treat your children when you're not present.

  1. Start by printing one copy of the medical release form for each child.
  2. Fill out the form completely. If you share custody or parenting responsibilities, be sure to include the other person's information and let them know that you're taking this step.
  3. Have the form notarized so it is legally binding. Do not sign any copies of your kid's medical consent forms until you're in the presence of the notary public. Signing them too early will nullify the entire process and you'll have to start over.

If you share legal custody with your child's other parent, make arrangements to have the form notarized together so you can both sign it. This is the best way to indicate that you both give consent for your child to receive treatment in the event that neither of you can be reached in an emergency.

Ensure It's Accurate and Legal

This is an important document; double-check that everything's correct. There are a few additional steps you should take to ensure your child has access to health care if you are not available.

  • Verify all of the phone numbers on the form.
  • Include primary and secondary insurance information.
  • Consider having multiple copies notarized for each child.
  • Keep notarized copies (not photocopies of the original) in multiple places. File one at your home, at your ex's home, and place one in your child's backpack. It's also best to keep a copy anywhere your child frequents on a regular basis, such as a babysitter's house.
  • Review the forms annually. If key information has changed, print new copies and start over. It's vitally important that all of the information be accurate and up to date.
Was this page helpful?