Healthcare Decision Guardianship Consent Letter

Date:

To Whom It May Concern,

This letter serves as a formal consent for guardianship regarding healthcare decisions for:

Full Name of Individual: Date of Birth: Address:

Guardian Information: Full Name of Guardian: Relationship to Individual: Address: Contact Number:

I/We, the undersigned, hereby provide consent and authorize the above-named guardian to make full healthcare decisions on behalf of the individual named above, including but not limited to medical treatments, hospitalizations, and other related healthcare services as required.

Special Instructions or Limitations:

Parent/Legal Guardian Signature: Date:

Witness Signature: Date: