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Minor Treatment Parental Consent Form Template

A printable consent form for treating a client under the age of majority, with guardian details, the treatment agreed, and the acknowledgements a parent or guardian should give.

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Last reviewed September 2026 · Not legal advice

Consent for minors is not one-size-fits-all

Who can consent for a minor depends on the province, the child's age and capacity, and the treatment. Many clinics decline elective cosmetic procedures for minors entirely, and some services, such as facials, may be offered with a guardian present.

Whatever your policy, record who is consenting, their relationship to the client, and that they were present or reachable. Ask your regulator and insurer what they expect for minors.

Clinic name · address · phone

Minor Treatment Parental Consent Form

Minor

Full name

Date of birth

Parent / guardian

Full name

Relationship to minor

Phone

Treatment

Treatment and area

Any allergies or medical conditions? Yes NoIf yes, details

Acknowledgements

InitialsI am the parent or legal guardian of the minor named above and can consent on their behalf.

InitialsThe treatment, its risks, and the alternatives have been explained to me and to the minor.

InitialsI will be present during treatment, or was reachable at the number above.

Signatures

Client / patient signature

Date

Practitioner name and signature

Date

Template from zdrovia.ca/templates/minor-parental-consent-form/ · Review with your medical director, regulatory college guidance, and insurer before use.

Send this form before the appointment instead of printing it

Zdrovia's form builder turns this template into a digital form your clients sign on their own phone. The signed copy files into their chart with the exact version they saw, and photo consent stays separate from treatment consent. It's free for solo practitioners, with data stored in Canada.

Start free, no card required See how digital forms work →

See how Zdrovia is set up for aestheticians.

Frequently asked questions

Should minors be treated at all?

That is a clinic policy decision. Many decline elective cosmetic procedures. Check your regulator and insurer.

Does the minor sign too?

Many clinics ask for the minor's assent alongside the guardian's consent.

This template is a starting point for discussion with your team and advisors, not legal or medical advice. Requirements vary by province and profession. Have your medical director, your regulatory college's guidance, and your malpractice insurer confirm the wording before you use it with patients.