Using this form, you give permission to other adults to act for you, in your absence, regarding the treatment of your child. This is a legal document.Authority to consent is contingent upon the child being in the legal custody of. ACS when medical services are required. Create a quick and hassle-free Medical Consent Form for minors with this easy-to-use template. Ensure smooth communication and authorization for medical care. This consent form should be taken with the child to the hospital or physician's office when the child is taken for treatment. 1. Enter the child's full legal name and date of birth. She approached my husband and asked for my daughter's pediatrician info and a medical authorization form. New York Child (Minor) Medical Consent Form.