Forms

Consent to Release

The Consent to Release may be used to give authorization 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. Please be aware that requests for information are processed in the order received and can take up to 2 weeks.

 

Immunization Record Verification by a Health Care Professional

Immunization Record Verification by a Health Care Professional can be used if you prefer to have your Healthcare provider sign a form to verify your immunizations. This form is not needed if you have documentation of your immunizations which can be directly uploaded to the patient portal. For more information about immunization requirements please go to the Immunizations page.

 

Immunization Waiver

The Immunization Exemption Form is required for individuals who are waiving the MMR vaccine for medical, religious, or personal reasons. Please be aware that all waiver forms must be signed by a licensed Healthcare provider who has discussed the risks and benefits of immunization. If student is ≥ 18 years old then they are required to sign the waiver.