The following forms are available for download in PDF format. You must have a PDF viewer installed on your device before you can view & print these forms. We recommend using Adobe Acrobat Reader.


  Asthma History Form
  Authorization and Consent for Treatment of Minors
  Authorization for Disclosure of Confidential Health Information
  Diabetes History Form
  Did Not Keep Appointment (DNKA) form
  Immunization History Form
  Nutrition Information Questionnaire
  Travel Consult Form
  Women's Health Patient Questionnaire

 

Optional Disclosure of Private Mental Health Information​​

In compliance with the Student Optional Disclosure of Private Mental Health Act, the university has established procedures for students to have the opportunity to authorize, in writing, the disclosure of certain private mental health information to a designated person. Access to this information will be provided only to qualified examiners.  To make such a disclosure, please click on the above link.

 



If you download and print these forms, please:

  • Please print forms longer than one page on both sides of the sheet.
  • Complete the forms in black ink.
  • Bring the completed forms to your appointment.