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Acknowledgement of Receipt of Notice of Privacy Practices

Authorization to Release Information in the Event of a Mental Health Crisis Form
In compliance with Louisiana Act No. 157 (R.S. 17:3138.1), Nicholls State University gives all enrolled students the opportunity to complete a voluntary mental health privacy authorization form. This form allows students to identify trusted individuals with whom the university may share important health information if a mental health crisis arises. Our goal is to ensure students receive the support they need.

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

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