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Apostille from the Utah Lieutenant Governor's Office

Consent for Medical Treatment of Minor - Utah

Utah · Fillable PDF · Free

A parent uses this form to let a babysitter, relative, coach, or other adult consent to medical or dental care for a child while the parent is away. A parent uses this form to let a babysitter, relative, coach, or other adult consent to medical or dental care for a child while the parent is away.

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Who this form is for

  • For Utah residents and families: consent for medical treatment of minor.

What you'll need

  • Read the supplied packet before filling in its fields.
  • Follow this document's signing, identification, witness and filing instructions.

How to complete it

  1. Fill in the child and adults (Page 1) Include the parents, the person giving consent, and the adult who may consent to treatment.
  2. Describe the treatment (Page 1) Authorize all advisable treatment or only specific treatment, and set the dates.
  3. Sign in front of a notary Do not sign ahead of time. Bring a current, government-issued photo ID for each person signing.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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