Sample Permission Letter for Medical Treatment (Consent)

It is a formal letter written by a guardian, caregiver, or medical practitioner to the parents of a minor requesting permission for his or her medical treatment. A permission letter for medical treatment is mainly sought by doctors when a minor child (minor) needs surgery or any other specialized treatment. The doctor may request that the guardian/caretaker of the child to seek the consent of the child’s parents before the child is allowed to receive the required medical treatment.

The letter simply informs the parents that their child is in need of medical treatment and the possible risks and side effects associated with the required treatment. Then, it requests the parents to give permission for their child to undergo the necessary medical treatment. Without the parent’s consent, the child may not be allowed to undergo any medical treatment.

This article will help you craft a permission letter for a minor’s medical treatment. We’ll also provide you with samples and free templates that you can download and use to come up with an effective letter when seeking medical consent from the child’s parents.

Sample Letters

Free Consent to Treat Minor Children Template for Word File

Free Medical Treatment Authorization and Consent Template for Word File

    Writing a Permission Letter for Medical Treatment

    To avoid miscommunication and ensure that the child’s parents give their permission for the child to undergo medical treatment, it is imperative that you write a clear and detailed letter. The letter should provide the parents with all the information they need in order to make their decision about whether to consent to their child’s medical treatment or not. The letter should also ensure that the child’s parents understand the risks and side effects of the treatment.

    The following is a detailed breakdown of how to properly craft the letter:

    Write the subject line

    The first thing that you will want to do is write a clear and descriptive subject line that accurately depicts your intention for writing the letter.


    If you seek the parent’s consent to perform minor surgery on the child, you can write the following as your subject line: “Requesting Medical Consent for Minor Surgery.”

    Add a greeting

    The next step when writing the letter is to add a greeting. The greeting should be formal and polite. In most cases, the greeting will be “Dear Mr. and Mrs. (Parent’s Surname) when addressing both parents. You can also use a more general greeting such as “Dear Parent(s)” to accommodate both parents in case you do not know the names of the child’s parents.

    Introduce yourself and your relationship with the child

    Next, include details of your relationship with the child. This can be relevant when writing a letter to the child’s parents whom you do not know personally. You can add in the letter that you are the child’s guardian or caretaker or any other relationship that will help establish your credibility.

    Include details of the child needing medical treatment

    Include in the letter the details of why you are seeking permission for the child’s medical treatment. Describe in detail what condition the child is suffering from and how the treatment will improve the health and well-being of the child.

    State the purpose of the letter

    State clearly in the letter why you need the parent’s consent to take the child to receive medical treatment. If the child has a condition that requires urgent medical attention, then make sure to enlist the urgency of the situation.

    Provide details of the medical treatment

    Provide details about the medical treatment that you need permission for. This can be in terms of a surgical procedure, an operation, or any other medical treatment the child needs, as it is essential that the parents know the exact medical treatment that you are seeking the consent for. Make sure to mention the hospital/doctor that will be administering the treatment and when the treatment is scheduled for.

    State your requirements

    Next, state what is required from the parents in terms of providing an authorization letter or any other document that will help you prove to the doctor/hospital that you are authorized to make decisions on behalf of the child. Make sure to state whether an authorization letter is needed, whether you need a contact number of the parents in case there are any questions at the hospital, and any other requirements that you may have.

    Provide your contact information

    Next, provide your contact information, including your name, address, phone number, and any other details that may be essential to the parents. This is vital as the parents can have additional questions about the treatment of their child.

    Sign off

    Lastly, sign off on the letter by reiterating the purpose of the letter and providing your signature and date. Before sending the letter, make sure to go through it several times and ensure that you have covered all the relevant areas.

    Template & Samples

    Given below are the template and sample letters that you can use to write your letter 


    [Your Name]

    [Your Position/Title (if applicable)]

    [Hospital/Clinic Name]


    [City, State, Zip Code]

    [Your Email Address]

    [Your Phone Number]


    [Parent/Guardian’s Name]


    [City, State, Zip Code]

    Dear [Parent/Guardian’s Name],

    I hope this letter finds you well. I am writing to discuss an important matter concerning the medical care of your child, [Child’s Name].

    As you may be aware, during our recent examination of [Child’s Name], we have identified a medical condition that requires [specific medical procedure or treatment]. After thorough evaluation and consideration, our medical team has recommended that [Child’s Name] undergo this procedure in order to address the condition and ensure their health and well-being.

    Before proceeding with the medical procedure, it is important for us to obtain your informed consent as [Child’s Name] is a minor. We understand that this may be a difficult decision for you to make, and we want to assure you that our team is committed to providing the best possible care for your child.

    We would like to take this opportunity to explain the details of the recommended procedure, including the benefits, risks, and any alternative treatment options that may be available. Our goal is to ensure that you have all the information you need to make an informed decision regarding [Child’s Name]’s medical care.

    We encourage you to ask any questions or express any concerns you may have about the proposed procedure. Our team is here to provide support and guidance every step of the way.

    Please take the time to review the information provided and discuss it with your family. Once you have reached a decision, please let us know your consent by signing and returning the enclosed consent form.

    If you require any further clarification or would like to schedule a consultation to discuss the procedure in more detail, please do not hesitate to contact our office at [Your Phone Number] or [Your Email Address].

    Thank you for entrusting us with the care of your child. We look forward to working together to ensure [Child’s Name]’s health and well-being.


    [Your Name]

    [Your Position/Title (if applicable)]

    [Hospital/Clinic Name]

    SAMPLE 01

    Dear Mr. and Mrs. Emerson,

    I hope this letter finds you well amidst these challenging times. My name is Dr. Alice Hartman, and I am a pediatric oncologist at Starlight Children’s Hospital. I have had the privilege of being entrusted with the care of your son, Ethan Emerson, since his recent diagnosis.

    As we discussed during our last consultation, Ethan has been diagnosed with a form of leukemia that, while serious, has a high rate of success when treated promptly and aggressively. Our multidisciplinary team has reviewed Ethan’s case in detail, and we have developed a comprehensive treatment plan tailored to his specific needs.

    Proposed Treatment Plan:

    The cornerstone of Ethan’s treatment will involve a combination of chemotherapy and radiation therapy, designed to target and eliminate cancer cells. This approach has been selected based on extensive research and has been proven to offer the best prognosis for children with Ethan’s type of leukemia.

    Details of the Proposed Treatment:

    • Chemotherapy: Ethan will undergo several rounds of chemotherapy, scheduled over the next few months. Each session will be carefully monitored by our pediatric oncology nurses and supported by medications to manage potential side effects.
    • Radiation Therapy: Following chemotherapy, Ethan will receive targeted radiation therapy to address any remaining cancer cells. This will be conducted with precision to minimize impact on healthy tissues.
    • Supportive Care: Throughout his treatment, Ethan will have access to our pediatric support services, including nutritional counseling, psychological support, and physical therapy, to ensure his well-being on all fronts.

    Consent and Understanding:

    Given Ethan’s age and as his legal guardian, we require your consent to proceed with this treatment plan. We understand this is an incredibly difficult decision, and we are here to provide all the information and support you need to feel confident in the choices made for Ethan’s care.

    Attached, you will find a detailed consent form outlining the specifics of the treatment plan, along with information on potential risks and benefits. We kindly ask you to review this document, and should you agree to the proposed treatment, please sign and return it to us by February 24, 20XX.

    We invite you to meet with us to discuss any questions or concerns you may have regarding Ethan’s treatment. Your understanding and consent are crucial, and we want to ensure you have every resource necessary to make informed decisions.

    Ethan’s health and recovery are our utmost priorities. With your support, we are hopeful for a positive outcome and are committed to providing Ethan with the best care possible.

    Thank you for your attention to this matter. Please do not hesitate to reach out to me directly at (555) 123-4567 or via email at to discuss any aspect of Ethan’s care.

    Warm regards,

    Dr. Alice Hartman

    Pediatric Oncologist

    Starlight Children’s Hospital

    SAMPLE 02

    Dear Ms. Rodriguez,

    I hope this letter finds you well. My name is Dr. Benjamin Lee, and I am a pediatric surgeon at Bright Futures Pediatric Hospital. I am writing to you regarding your daughter, Sofia Rodriguez, whom I had the pleasure of examining on February 19, 20XX.

    During Sofia’s recent visit, we discussed her diagnosis of appendicitis and the necessity for a prompt surgical intervention to prevent any complications. The procedure we recommend is an appendectomy, which is a common and straightforward surgery with a high success rate.

    Details of the recommended surgery:

    • Nature of Surgery: Laparoscopic Appendectomy
    • Purpose: To remove Sofia’s inflamed appendix, thereby preventing the risk of rupture and subsequent infections.
    • Procedure Overview: This minimally invasive surgery involves making a few small incisions through which surgical tools and a camera are inserted. The inflamed appendix will be removed, minimizing recovery time and discomfort.
    • Estimated Duration: The surgery is expected to last approximately 1 hour.
    • Recovery Time: Sofia will need to stay in the hospital for 1-2 days following the surgery for monitoring. Full recovery typically takes about 2 weeks, during which she may return to school but should avoid strenuous activities.

    As Sofia is under the age of 18, we require parental consent to proceed with the recommended surgery. We understand that the decision to agree to surgery for your child is significant, and we are here to provide all the necessary information to help you make an informed choice.

    Attached to this letter, you will find a Consent Form detailing the surgery, potential risks, and benefits. Please review this document carefully. If you agree to proceed with the surgery, kindly sign and return the consent form to us by February 24, 20XX.

    We believe in the importance of open communication and are here to address any concerns or questions you may have about the surgery. Please feel free to contact me directly at (310) 555-7890 or schedule a consultation to discuss further.

    Your daughter’s health and well-being are our top priorities, and we are committed to providing her with the best possible care. We appreciate your trust in Bright Futures Pediatric Hospital and look forward to supporting Sofia through her surgery and recovery.

    Thank you for your attention and cooperation. We await your response and are ready to assist in any way we can.

    Warm regards,

    Dr. Benjamin Lee

    Pediatric Surgeon

    Bright Futures Pediatric Hospital

    Sample 03

    Dear Mr. and Mrs. Thompson,

    I am writing to you as Lucas’s pediatrician regarding a necessary medical intervention to address his recurrent ear infections (otitis media) which have not responded to standard treatments.

    Recommended Treatment: Myringotomy with tube insertion

    • Objective: To alleviate Lucas’s discomfort, prevent further infections, and mitigate the risk of hearing loss.
    • Procedure Brief: A small incision is made in the eardrum to drain fluid and a tiny tube is inserted to ventilate the middle ear. This outpatient procedure is low-risk, performed under general anesthesia, and takes about 15 minutes.
    • Recovery: Lucas can return home the same day, with a follow-up visit scheduled after one week. He may resume normal activities within a few days, avoiding water in the ears until advised.

    Lucas is a minor, and this procedure requires parental consent to proceed. Your approval is crucial for us to address his condition promptly.

    Please review the attached Consent Form detailing the procedure, risks, and benefits. If you agree, sign and return the form by March 1, 20XX. Do not hesitate to contact me for any clarifications or to discuss further.

    We prioritize Lucas’s health and are confident this procedure will significantly improve his quality of life. Your prompt response will enable us to schedule the procedure at your earliest convenience.

    Thank you for your attention to this matter. Looking forward to your response.

    Best regards,

    Dr. Emily Carter

    Chief Pediatrician, New Horizons Children’s Clinic

    (802) 555-0123

    Key Takeaways

    These sample letters are excellent examples of effective communication between healthcare professionals and patients or their guardians. Here’s why:

    Clear Explanation of Diagnosis and Treatment: Each letter begins with a clear explanation of the patient’s diagnosis and the recommended treatment plan. This helps the recipients understand the medical situation and the proposed course of action.

    Detailed Description of Procedures: The letters provide detailed descriptions of the proposed medical procedures, including the nature of the surgery or intervention, its purpose, and the expected duration and recovery time. This information helps alleviate any concerns or anxieties the recipients may have about the procedures.

    Request for Consent: In each case, the letters request consent from the patient or their guardians to proceed with the recommended treatment. This demonstrates respect for the recipient’s autonomy and ensures that they are fully informed and involved in the decision-making process regarding their healthcare.

    Offer of Support and Information: The letters emphasize the healthcare provider’s availability to address any questions or concerns the recipients may have about the proposed treatment. This offer of support helps build trust and confidence in the healthcare provider and fosters open communication between the provider and the recipients.

    Clear Instructions for Response: Each letter provides clear instructions for how the recipients can respond to indicate their consent or seek further information. This ensures that the communication is actionable and facilitates prompt decision-making regarding the proposed treatment.

    Overall, these letters effectively convey important medical information to the recipients in a clear, respectful, and compassionate manner, demonstrating the healthcare provider’s commitment to patient-centered care.

    Final Thoughts

    Getting a child’s parents to consent to medical treatment is vital if you want to ensure that he or she receives safe and effective treatment. The parents should be aware of all the medical risks involved in medical treatment, and they should also be aware that their child will be participating in the medical treatment if they give consent.
    The consent letter should be worded in a simple and straightforward manner so that the parents do not have any difficulty giving their approval. The letter should also include information about the child, details about the type of treatment required, whether a consent form is required, the date and time of the surgery, and other relevant information.

    About This Article

    William Lehr
    Authored by:
    Human Resources Specialist, MS Office Expert
    William Lehr combines a profound understanding of human resources with a certified expertise in Microsoft Office, making him a dual asset in any professional setting. With a keen insight into the intricacies of HR, William adeptly manages talent acquisition, employee relations, and organizational development. His Microsoft Office proficiency further amplifies his effectiveness, allowing him to design and implement seamless workflows, reports, and analytical tools. Whether it's optimizing HR processes or crafting efficient MS Office solutions, William's comprehensive skill set ensures that organizational objectives are met with precision and excellence.

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