Authorization for Treatment of Minors

Students who are under 18 years of age and are participating in non-degree Columbia University programs (e.g. Summer High School, Bridge Program, School at Columbia) must have a record of parental or guardian authorization for medical care and counseling services  on file with Columbia Health prior to receiving care.

Students, please have your parent or guardian sign the form below and email to [email protected].

Note: Students under 18 who are enrolled in a degree-granting program at Columbia University do not need to submit this form.