17 Years Old & Under

Incoming students who are 17 years old and younger must submit a completed Health History Form and Privacy Notice Form prior to registering for classes.

Instructions:

1. Print out the Student Health History form.

2. Read and complete all sections of the form, including a signature from your parent or guardian on pages 1 and 3.

3. Write your initials on the blank located at the lower left corner of the first page of the Privacy Notice (page 2) and complete all blanks of page 3.

4. Submit the completed forms to UTSA Student Health Services by one of four ways: in person, by fax, by mail or by email.

    UTSA Student Health Services
    One UTSA Circle, RWC 1.500
    San Antonio, TX 78249
    Fax: (210) 458-4151
    Email: StudentHealthServices@utsa.edu

Downtown campus clinic:

    UTSA Student Health Services-Downtown
    501 E. Cesar E. Chavez Blvd
    San Antonio, TX 78207
    Fax: (210) 458-2935