The following consent forms must be completed by a parent or legal guardian for UH students under the age of 18 years old before an appointment can be scheduled.
Please print, complete and physically sign the forms.
Digital signatures are not accepted.
Completed forms can be submitted by:
MAIL: Submit the completed form by mail.
UH Student Health Center
Attn: Medical Records
Health 2, 4349 Martin Luther King Blvd., Room 2005
Houston, TX 77204-3019
UPLOAD: Submit the completed form in PDF format through our Healthy Coog Patient Portal. Currently enrolled students only.
- Select Messages
- Select "I want to upload my Authorization for the Treatment of a Minor Consent Form with my parent/guardian signature".
- Follow the instructions to upload your form
Due to privacy regulations, we are unable to accept submissions by email.
If you are under the age of 18 years old, cannot obtain parental/guardian consent, and need medical care from a Student Health Center clinician, please call 713-743-5151, Option 4, to speak to a Patient Services Specialist.