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 when they arrive on campus or at the start of the semester, 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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To Submit this form, or Get Help

University at Buffalo
4350 Maple Rd
Amherst, NY 14226

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