UNIVERSITY HEALTH SERVICES

Forms and More Information

FORMS: (Adobe Reader is required to view these documents)

Acknowledgement of Receipt of Notice of Privacy Practices

Consent to Treatment

COVID-19 Vaccine Exemption Form (Electronic version*For use by Nursing/Allied Health students and faculty only!*

Health History Form

Immunization Compliance

Immunization Waiver

Incident Report (online) or Incident Report (PDF)

Notice of Privacy Practices

Release of Information Consent

Student Physical Form

TB Symptom Screen *For use by Nursing/Allied Health students and faculty only!*

Telehealth Patient Consent Form

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