Parental Consent Form

Allow Student Health Services to provide health care to a student who is under 18 years of age.

This form must be completed if the student is under 18 years of age at the time of arrival on campus, even if the student will turn 18 during the academic year. Student Health Services cannot treat minors without written consent from a parent or guardian.

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University at Buffalo
Michael Hall, 3435 Main Street, South Campus
Buffalo, NY 14214

Phone: (716) 829-3316; Fax: (716) 829-2564