Consent Forms

Digital Minor Consent Form

Digital submissions available in English and Spanish

To be completed by the parent or guardian of any minor under 14 who wishes to receive care.

Complete Form

Digital Non-Minor Consent Form

Digital submissions available in English and Spanish

To be completed by anyone 14 or older who wishes to receive care.

Complete Form

Download a Consent Form

Minor Consent Forms

To be completed by the parent or guardian of any minor student under 14 who wishes to receive care. Please bring the completed form to the mobile clinic.

English
Spanish
Kinyarwanda
Swahili
Vietnamese

Non-Minor Consent Forms

To be completed by any student 14 or older who wishes to receive care. Please bring the completed form to the mobile clinic.

English
Spanish
Kinyarwanda
Swahili
Vietnamese