Do not sign this document until the notary is present.

Arizona law requires that the notary witness your signature in person. Signing in advance can invalidate the notarization and require you to start over.

Before you prepare this authorization

This letter authorizes another adult to consent to medical care — it does not replace a court-ordered guardianship or healthcare power of attorney.
If both parents share custody, both should sign. A hospital may refuse the letter if only one parent signs and the other has joint legal custody.
Keep allergies, medications, and emergency contacts current. Out-of-date medical info on a notarized letter can be dangerous.
NotaryBolt is not a law firm and does not provide medical or legal advice. For complex situations (custody disputes, special-needs care, advance directives), consult an attorney.

About the patient

Details about the minor or dependent receiving care.

Patient's full legal nameRequired

Patient's date of birthRequired

Patient's home addressRequired

Patient's sexOptional

Weight (lbs)Optional

Blood typeOptional

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