Health History Form [PDF]
Fill out this form before your first appointment. Also available online through MyHealthSpace.
A full list of forms needed for the different services offered through Student Health Services. Some forms can be completed online using MyHealthSpace.
Some forms are also available online through MyHealthSpace, where noted.
Fill out this form before your first appointment. Also available online through MyHealthSpace.
Complete this form to release certain health records to an outside doctor, insurance company or family member.
Complete this form to file an insurance claim with your provider. Also available online though MyHealthSpace.
This form needs to be completed and on file with Student Health Services before your orientation to avoid a hold on your class registration. When you log in to MyHealthSpace, go to the “Forms” tab, enter your immunization information, fill out the form and after your doctor signs the form, please mail or fax it back to Student Health Services.
Understand how your medical information is stored, who can access it and how it may be used or disclosed. Also available online through MyHealthSpace.
Complete this form to receive treatment recommended by Student Health Services health providers. Also available online through MyHealthSpace.
Fax this form to Student Health Services to transfer your prescriptions to or from another pharmacy.
If you are planning to travel abroad, bring this completed form with you to your travel consultation with the Travel Clinic.