Medical Permission Slip Template
Parental Information
Child's Information
Child's Medical Information
- In case of emergency and I am unable to be reached, I authorize medical treatment to be given to my child by a licensed medical professional. This authorization includes any necessary tests, procedures, or medications that the medical professional deems necessary for the treatment of my child's medical condition.
- I understand that the medical professional will make every effort to contact me or the emergency contact listed above prior to administering any medical treatment to my child, unless it is determined that immediate treatment is required.
- I certify that my child is not allergic to any medications and does not have any medical conditions that would prevent him/her from receiving medical treatment.
- I understand that this consent form will remain in effect until revoked by me in writing.
For medical professionals, it’s imperative to have permission slips and release forms for your patients to fill out — from medical record release forms to vaccination forms. With Jotform, you can easily build your own professional medical permission slip PDFs. All you need to do is include your information and applicable signature fields, then send the attached form directly to patients to fill out — their submissions will convert to PDFs automatically upon completion.
Customize your medical permission slips to work for your practice’s exact needs with our easy-to-use online builder. Drag and drop to pick fonts and colors, integrate with widgets, upload helpful videos or images, and more! Once you’re finished personalizing your permission slips, send them out via direct link, QR code, or by embedding it into your online patient portal or website.
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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.