Minor Consent for Treatment

17 Years and Younger

Incoming students who are 17 years old and younger must complete and submit one of the forms below prior to registering for classes.

Consent for Minor by Parent or Guardian

Print out and complete the Consent for Treatment of a Minor who does not have Legal Power to Consent form if none of the below qualifications apply to you. Read and complete all sections of the appropriate form, including a signature from your parent or guardian (if applicable).

Consent by Minor

Print out and complete the Consent By Minor to Own Treatment form if at least one of the below apply.:
    1. You are on active duty with the armed forces of the United States of America.

    2. You are 16 years of age or older and reside separate and apart from his/her parents, managing conservator, or guardian (whether with or without the consent of the parents, managing conservator, or guardian and regardless of the duration of the residence), and is managing his/her own financial affairs (regardless of the source of the income).

    3. You are consenting to diagnosis and treatment of any infectious, contagious, or communicable disease which is reported to the Texas Department of Health.

    4. You are an emancipated minor.

Submit the Completed Form

Submit the completed form to UTSA Wellness 360 in one of four ways: in person, by fax, by mail, or by email.
Main Campus Clinic
UTSA Wellness 360
One UTSA Circle, RWC 1.500
San Antonio, TX 78249
Fax: (210) 458-4151