Writing a Permission Letter to Take Child to Doctor [Free Sample]

A permission letter to take child to doctor allows someone other than a parent or legal guardian to authorize medical treatment for a child, senior citizen or other person mentioned in the letter. 

It’s a very important document if the primary caregiver is out of town or otherwise not available to authorize treatment.

medical treatment

Authorization for medical treatment for a child or other individual can only be given by the lawful guardian of the person. 

This type of letter may also be given to a specific doctor at an assisted living facility where an elderly person resides who is under the care of a legal guardian.

This permission letter is usually written for an individual who is at least 18 years of age, and it is not recommended to write an authorization letter to a school or day care center because the legal guardian may not have control over which person gives authorization for treatment.

Legal Guardian

If the legal guardian has a preferred local physician, a copy of the letter can be given to his or her office. 

If there are any treatments that are not acceptable to the legal guardian, these need to be mentioned in the letter. It is also recommended that the letter have an expiration date.

In some cases, this type of letter is routinely given to a nanny, babysitter or other regular caregiver, so if the occasion arises, the child will not need to wait for medical treatment. 

In any case, a medical authorization letter should only be given to someone whom the legal guardian trusts.

Temporary caregiver

If the temporary caregiver doesn’t have written permission to authorize treatment, the child may have to wait until the legal guardian returns to get proper treatment. If the treatment is urgent this could endanger the life of the child.

The permission letter should be addressed to a specific doctor or hospital where treatment will be sought. 

If this information isn’t known, the letter can be addressed To Whom It May Concern. The purpose of the letter should be stated in the first sentence.

Another occasion where a permission letter may be needed is if a child is traveling with friends or on a school trip where the legal guardian is not present. 

It will give a member of the other family, a teacher or other chaperone legal permission to make medical decisions for a child.

Legal Guardian

Before writing a permission letter, the legal guardian should check with their family doctor or the child’s school to find out if there are any required forms that need to be filled out and signed by the parent or legal guardian. 

It is also recommended for the legal guardian or parent to check if there are any legal requirements in their state that need to be fulfilled in order for the authorization to be effective.

The letter must contain:

  1. The names and addresses of the legal guardian and the person to whom the authorization is being given
  2. The names and birth dates of all children involved
  3. The purpose of the letter and giving medical treatment authorization

Some medical consent forms may contain the following points, but they are not required to create a legal document:

  1. The lawful guardian has no court orders that prevent him or her from conferring the power of medical authorization upon another individual.
  2. The guardian may give a list of treatments such as transportation by ambulance, x-rays, medication, anesthesia or others that are allowed.
  3. The letter may state the reason why the authorization is being given to someone else. 
  4. The letter may state that the authorization is being given freely and not under pressure, threat, or payments from any agency. 
  5. Any special health issues the child may have

Below is a permission letter to take child to doctor. 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 Permission Letter To Take Child To Doctor

Your Name
Your Address
City, State, Zip Code


RE: Permission Letter

To [Name of Doctor]:

I, [Name of Legal Guardian], am the female child listed below’s legal guardian. I offer [Name, Address, and Phone Number of Temporary Caregiver] permission and agree to authorizing medical treatment for [Full Name of Child] and [Date of Birth].

This authorization is valid from [DATE] to [DATE] and will end on [DATE].

Signature               DATE
Your Name

Signature of Witness or Notary (if required by the state) DATE
Name of Witness

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