Form: Health Surrogates for Children

Authored By: Florida Justice Technology Center


This form allows a parent to name another person a “health care surrogate” for a minor child. 

The health care surrogate can allow doctors to treat a minor in case of an emergency or non-emergency when the parent is unavailable. This form could be used if the minor children is traveling or staying with relatives or friends while a parent is away.

This form must be signed by two witnesses to name a “health care surrogate” for a minor child. The witnesses cannot be the friend or relative who is named the health care surrogate.   

Updated: May 4, 2017 

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