This form provides parental permission for a child and/or family to receive health consultation services such as assessments, observations, screenings and consultations that will be provided onsite at the child care setting. It also permits sharing of the information between the child care staff and the health professional for the purpose of understanding and addressing the child's or family's needs.
This form was developed through a collaboration between Abby J. Cohen, J.D and CCHP.
Updated September 2022, UCSF California Childcare Health Program
