The Authorization to Disclose Health Care Information may be used to give consent for disclosure of your health records to the Student Health Center OR if you need records released from the SHC to another provider or clinic.
Complete this form and return to the SHC by email, fax, mail, or in person. Please be aware that requests for information are processed in the order received and can take up to 2 weeks from the time received.
For students under the age of 18 years old, a Minor Consent for Care for may need to be signed by a parent/legal guardian prior to services being provided at the Student Health Center.
Immunization Form for Healthcare Provider This form is not needed if you have acceptable documentation of the required immunizations but is an option.
Proof of measles immunity and COVID-19 vaccination is required for the 21-22 academic year. If you have a medical or relgious reason that prevents you from receiving a vaccination you may submit an exemption request to the Student Health Center. Philosophical reasons will no longer be accepted exemption.
Medical Immunization Exemption form
Religious Immunization Exemption form