Student Health Services

Forms

 

   a photo of forms

While most forms are available by logging into Medicat, here are downloadable forms in the event that they are needed. 

**NEW STUDENT/FRESHMAN HEALTH PAPERWORK** (we will accept physicals up to 2 years old for non-athletes)

Please download these forms to your desktop and complete them in Adobe or print and upload into Medicat. If you complete the forms in a web browser, they will not save properly. 

Physical Form - If your provider does not wish to complete this form, you may attach copies of your immunization records and your most recent physical. 

Meningococcal Disease Fact Sheet

Meningitis Vaccination Response Form - Meningitis ACWY Vaccine must be given within 5 years of the start of classes. If your Meningitis Vaccine was given more than 5 years ago, please check the bottom box on this form in order to fulfill the requirement. 

Minor Consent Form - Required only for students under the age of 18 years old

Tuberculosis Screening Questionnaire 

Exemption Forms for MMR Requirements ONLY:

Medical Exemption Form for MMR Vaccinations

Religious Exemption Form for MMR Vaccinations 

 

Pre-Appointment Forms:

The following forms are only to be completed if asked to do so by a Triage Nurse for an appointment at SHS.

Emergency Contraception Form

Injury Report

Overseas Academic Programs Form

Sexual Health History Form

Testosterone Administration Form

Urine Screening Form

 

Additional Forms:

The following forms are only to be completed if you choose not to complete the Physical Form. The Physical Form is not mandatory but it is strongly recommended for students who are planning to use the services offered at the Student Health Service.

Demographics - Included in the Physical

Health History - Included in the Physical

Allergy Questionnaire - Required only for students with allergies to foods/stinging insects. 

Asthma Questionnaire - Required only for students with a history of Asthma.

Immunization Records Request Form 

Leave of Absence Form - For more info., please click the following link: Leave of Absence. 

 

Release of Records:

Release of Records From Student Health Service 

Release of Records To Student Health Service 

 

**Please note, if you are a returning student and you have already submitted your health records the previous year/semester, then you do not need to resubmit any information. The information you submit as a Freshman/Transfer student will cover you through graduation.**