Health Services

Forms

Health Services Forms

Health Information Privacy Rights
What the law says about privacy of your health information.

Health Information Form
Students are required to submit this form. It includes your personal medical history, your family’s medical history, and the consent to be treated.

Health Information Release Form
Students in need of copies from their medical file must fill out this form. Once submitted, requests will be addressed within two business days (exception being the first two weeks of fall quarter each year).

Immunization Compliance Form
Students who have not been vaccinated in the past are allowed to submit this form. In the event of an outbreak these students will be required to leave campus. For a list of the adult immunizations recommended go to www.cdc.gov under Vaccines You Need as an Adult.

Meningitis
Information on Meningococcal disease and preventative vaccination.

Tuberculosis Skin Test
Students must have a TB skin test (or other form of tuberculosis clearance testing) from their medical provider within the last 12 months. You can attach this to your submitted documents, or once obtained, include on your physical examination form.

Tuberculosis Screening Form
Student born in another country and/or have had extensive contact in endemic areas are required to submit this form.

*These need to be completed only one time before you enroll for the first time, not needed yearly. Specific majors may have additional requirements so please check with your department.