FORMS

DIRECTIONS:

Please print the form(s) you need, complete in ink, and return to the Student Health Center. 

Our site does not support on-line completion of forms at this time.  We apologize for any inconvenience.

1. THE FOLLOWING 2 PAGE ENCOUNTER FORM IS FOR MEDICAL VISITS (Complete appropriate areas of both pages).

   1. PAGE 1 (Every visit).

   2. PAGE 2 (All NEW patients then at least once per year)

2. HIV CONSENT

3. PARENTAL CONSENT FOR MINORS

4. PRIVACY NOTICE

5. CONSENT FOR RELEASE OF MEDICAL RECORDS

6. NEW CLIENT PACKET - COUNSELING SERVICES (Read the "Privacy Notice Brochure", then print, complete, and bring all other forms to appointment)

7. MOOD ASSESSMENT

8. Consent