Use of this form is voluntary, but completion will aid caretakers in ensuring that appropriate and timely health care is provided.
Dental care: routine dental care is diagnostic and preventative services and treatment including restoring teeth, tooth extractions, and use of nitrous oxide.
Medical services: all medical services will be under the direction of a licensed dental care provider or physician or other licensed professional as appropriate.
Emergency surgery: if the parent or guardian cannot be located within a reasonable time, the placing agency has the authority to consent to emergency surgery.
Child's signature: age 14 and over only.
Instructions: if additional space is needed, attach a separate sheet, or use reverse side of this form.
| Question | Answer |
|---|---|
| Form Name | Form DCF-F-CFS0997-E |
| Form Length | 1 page |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Edition | Rev 08/2023 |
| Issuing agency | Department of Children and Families, Division of Safety and Permanence |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | DCF-F-CFS0997-E, DCF-F-CFS0997, CFS0997, Wisconsin DCF medical consent, Medical Services Consent |
| Official source | Form DCF-F-CFS0997-E (Rev 08/2023), Wisconsin Department of Children and Families |
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