Providing cost effective, accessible, professional health care to the campus community
Resources and Links
Forms
All students:
- Acknowledgement of Receipt of Privacy Notice (pdf)
- Condom Request Form (pdf)
- Medical History Form(pdf)
- Hepatitis A Vaccine (pdf)
- Hepatitis A Vaccine Administration Record (pdf)
- Hepatitis B Vaccine (pdf)
- Hepatitis B Vaccine Administration Record (pdf)
- Immunization Compliance (pdf)
- Immunization Fact Sheet(pdf)
- Required Immunization Information (pdf)
- Seasonal Influenza Vaccine Consent Form 2011-2012(pdf)
- Inactivated Influenza Vaccine Information 2011-2012
- Meningitis vaccine Consent Form (pdf)
- Meningococcal Vaccines (pdf)
- MMR and/or Tdap Consent Form (pdf)
- MMR Vaccines (pdf)
- Adult Tetanus,Diphtheria and Pertussis Vaccine (pdf)
Athlete Forms (print, complete/review):
- Athletic Health Consent Form (pdf)
- Acknowledgement of Receipt of Privacy Notice (pdf)
- New Athlete Medical History (pdf)
- New Athlete Orthopedic Physical Evaluation (pdf)
- Returning Athlete Medical History (pdf)
- TB Risk Assessment (pdf)
- NCAA Sickle Cell Trait (for student athletes) (pdf)
- NCAA Sickle Cell Trait (for coaches) (pdf)
Consent Forms:
- Authorization for Release (pdf)
- Health Service Authorization and Consent for Treatment for Minors (pdf)
Gynecology Forms (complete for each annual appointment):
Student Teacher Form:
Travel Form (complete prior to scheduling $25 consult):
