With the 2025-26 school year well underway, San Antonio area school districts have taken inconsistent approaches complying with a new state mandate requiring schools to get parental consent for most student health services.
The mandate for new parental consent forms is only a small bite of a much larger piece of Republican-led legislation championing parental rights, and it’s caused confusion among school employees who provide students health services.
Passed during the 89th Legislative Session, Senate Bill 12 went into effect as soon as it was signed into law in June, giving school districts less time to implement the new mandates. The law bans diversity, equity and inclusion practices, instruction on sexual orientation and gender identity and LGBTQ+ student clubs.
Education experts say school districts will be adopting new policies related to SB 12 for months to come, but the medical consent form portion is one of the more pressing items.
Which health services can parents control?
SB 12 requires parents to opt in or out on behalf of their child for any health care, mental health or health-related services a public school might provide.
Services that require parental consent include:
- Administration of over-the-counter medications
- Administration of prescription medications
- Monitoring of chronic health conditions like asthma or diabetes
- Vision, hearing, and scoliosis screenings
- Lice screening
- Risk assessments for Type 2 Diabetes in children
Services that don’t need parental consent include:
- General caretaking, or noninvasive actions taken when a child claims feeling unwell
- Medical emergencies or those required by law
- Immediate student safety situations
- Support during illness or physical symptoms at school
- Heat illness prevention and injury support for student athletes
On the mental health front, schools need parental consent to provide individual counseling, small group counseling, behavioral observation and referrals to other mental health providers.
Students are allowed to consent to their own counseling when it comes to suicide and self-harm prevention, grief support after traumatic events or situations involving suspected neglect, abuse or drug addiction.
Parents will be asked to send medical consent forms every school year.
School districts send forms with little guidance
San Antonio Independent School District was one of the first districts in San Antonio to release parental consent forms in late August, asking parents to complete and return the forms by Sept. 5.
So far, the district has received forms back from parents for at least half of its students.
Initially offering guidance on the new consent forms on Aug. 28, the Texas Education Agency released more instructions on Sept. 11 after receiving questions from “various stakeholders” wanting clarity on which services school nurses and counselors were allowed to provide without getting a yes from parents.
“Since the original guidance was released, school systems and parents have raised questions about which services related to a student’s health require active, informed consent,” the TEA wrote to school administrators.
The TEA also shared a draft of “potential rules” that could change during the agency’s rulemaking process, which includes gathering public input.
In its update, the TEA made a distinction between “health-related” and “health-care” services.
Health-related services don’t require parental consent and the agency defines them as short-term, noninvasive activities designed to promote a student’s overall wellbeing. Examples include first aid, mental health screenings, suicide and substance abuse prevention or vision/scoliosis screenings.
Health-care services, according to the TEA’s first draft, require signed consent and meet the definition of either psychological or psychiatric examination, psychological or psychiatric treatment and dispensing medicine.
SAISD’s form asks parents to grant or refuse consent for all of the services schools usually provide or write down which specific services they don’t consent to.
Like SAISD, Northside ISD released forms before TEA issued further guidance. The district emailed parents on Sept. 8 asking them to fill out consent forms and turn them in by Sept. 19.
Northside’s form asked parents two questions: whether to opt in or out of school health services and whether to opt in or out of school-based mental health services. As of Sept. 22, the district was at a 37% consent form completion rate.
“Parents wishing to withhold consent for or decline any individual health related or mental health service can also contact their child’s school directly for further assistance,” Northside wrote.
Northside’s parent forms also note all district employees are legally required to report alleged abuse or neglect of a student and can ask a student about their well-being without parental consent.
“Because of the need for further clarity that has been expressed … especially for those school systems that have established a blanket opt-in requirement for all services TEA expects those school systems to update their forms to align with this updated guidance and the original statute as quickly as is practical,” the agency wrote.
IDEA Public Schools, a charter district with 15 schools in San Antonio, is issuing brand new consent forms to “ensure full compliance with the law.” The district says forms sent before TEA’s updated guidance were compliant with the law, but updated versions are being sent based on the agency’s new directions.
“IDEA values the trust families place in us, and we are dedicated to keeping parents informed and engaged in decisions affecting their children,” a spokesperson for IDEA Public Schools said. “Updated consent forms will be distributed to families in the coming weeks.”
Some schools districts take longer approach
Other San Antonio school districts have been slower to send parents the consent forms as they wait for more guidance or work out the kinks on an implementation process.
North East ISD and Alamo Heights ISD, for example, haven’t sent out medical consent forms as of time of publication.
Alamo Heights is reviewing guidance from the Texas Association of School Boards, which just released new guidelines based on TEA’s Sept. 11 update.
North East is currently developing a new application within its own system so parents’ preferences are logged correctly, said district spokesperson Aubrey Chancellor. After collecting forms, the district’s nurses will receive training on the system.
“We want to ensure compliance but implementation takes time,” Chancellor said. “We want it to be convenient for parents but it must be accurate.”
The district plans to send out forms next week.