Consent for medical and dental treatment form

Logo of the Office of the Public Guardian - the letters OPG in blue and green, on a white background

Consent to carry out medical treatment for a person under the Guardianship of the Public Guardian (Guardianship and Administration Act 1995)

Please note, substitute consent is not required from the guardian when:

  • the practitioner believes the person has capacity to consent to the proposed treatment;
  • when the treatment is minor, including non-intrusive examinations, non-prescription medication
    and first aid (S. 3 GAA).
Patient details
Date of birth *
Patient details

Consent by the Guardian will be provided in writing, preferably by email. Please provide your email address, or other alternative method of contact.

Treatment details
Date
Date *
Guardian's signature
Updated: 31st January 2024