Consent for Treatment
If you’re 17 or younger, we’ll need a Consent for Treatment form signed and submitted by your parent or guardian.
I’m under 18, how do I submit this form?
You are required to submit one of the following forms to UTSA Student Health Services by:
- In Person: Main Campus: Recreation Wellness Center, room 1.500
- Mail: UTSA Wellness 360, One UTSA Circle, San Antonio, TX 78249
- Fax: (210) 458-4151
- Scan and Email: wellness360@utsa.edu
Which form do I submit?
Consent by Minor to Own Treatment Form
If you meet the below criteria, fill out the Consent by Minor to Own Treatment Form
- Active Duty U.S. Military
- 16 years of age or older and live apart from your parents, managing conservator or guardian, and are managing your own finances
- consenting to receive diagnosis and treatment of any infectious, contagious or communicable disease which is reported to the Texas Department of Health
- an emancipated minor
Consent by Minor to Own Treatment who Does Not have Legal Power to Consent
If you do not meet any of the above criteria, submit the below Consent by Minor to Own Treatment who Does Not have Legal Power to Consent. This form must include a signature from your parent or guardian.
Consent by Minor who Does Not have Legal Power to Consent