Medical Care Authorization Form


Medical Care Authorization Form
I ____________________of ____________________ do hereby appoint
_____________________of ____________________to seek and obtain medical
care and treatment for my children, ____________________________________
which he/she believes to be necessary for the health and well being of my said
child/children including any surgery authorized by a licensed physician.
I give and grant unto him/her full power and authority to do and perform all and
every act, deed and matter and things whatsoever to promote the health and
welfare of my said child/children as fully and effectually to all intents and
purposes as I might or could do in my own proper person if personally present. I
hereby declare that any act or thing lawfully done hereunder shall be binding on
Dated this ______day of____________________20______
Signature of parent or legal guardian


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Parent category: Business