Parental Consent Form

If you are traveling and have to leave your children in the care of someone else, be sure to always leave written authorization so your children can receive emergency medical treatment in your absence, if needed. Simply download the parental consent form, print it, complete it, and leave it with your children's caregiver. You'll need a separate, dated form for each child each time you leave town.

To view the Parental Consent Form, you'll need the free Adobe Acrobat Reader.

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LUTHERAN HEALTH NETWORK
BLUFFTON REGIONAL MEDICAL CENTER | DUKES MEMORIAL HOSPITAL |
DUPONT HOSPITAL* | KOSCIUSKO COMMUNITY HOSPITAL* |
LUTHERAN HEALTH PHYSICIANS | LUTHERAN HOSPITAL* | MEDSTAT |
THE ORTHOPEDIC HOSPITAL* | REDIMED | REHABILITATION HOSPITAL* |
ST. JOSEPH HOSPITAL*

*A physician owned hospital.

If you are experiencing a medical emergency, call 911.

Working hand-in-hand with pediatricians and specialists, Lutheran Children's Hospital offers families expert pediatric medical care in an environment filled with imagination and color. The Lutheran Children's Hospital is located inside Lutheran Hospital at 7950 W. Jefferson Blvd., Fort Wayne, IN 46804
(260) 435-2699.

*ER wait times are door to clinical professional and can change quickly depending on the urgency of patients that arrive by ambulance. Lutheran Health Network provides care to patients with life-threatening illnesses first.

Lutheran Hospital is owned in part by physicians.

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