Grandparent Medical Consent Form

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The grandparent’s medical consent form is a document that allows someone else to be able to make medical decisions for the elderly person. This form is not meant for permanent situations as a Medical Power of Attorney should be created if the caregiver will be in charge of making decisions for a long period of time.

Signature – The form should be signed in the presence of at least one (1) witness that is not family.

Child Consent – Use if a parent or guardian would like the grandparent to have control of making medical decisions for a minor child in the family.

How to Write

Step 1 – Download in Adobe PDF (.pdf) or Microsoft Word (.docx).

Grandparent’s Medical Consent FormPDFWord

Step 2 – Read through all the information provided on the page to start. Next, in the first available field, enter your name. The following five (5) fields can be filled in with this data:

  • Relationship to the individual receiving care
  • Full name of the dependent
  • Name of caregiver
  • Start date of care
  • End date of care

Step 3 – The first two fields of the left-hand column are for signatures. Leave those blank until after the document has been printed. A witness must sign and be present for the signature of the legal guardian. Enter that witness’s name, full address, and phone number. Next, the health carrier’s policy, group number, and policy number should be submitted. Finally, if there are any allergies which the dependent suffers from, supply them here.

Step 4 – The primary physician’s name, contact info, and address must be given. Below this, enter the current medications, the date of the last tetanus booster, and medications dependent is taking.

Step 5 – Print off the document and supply the aforementioned signatures.