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Forms

New Student Requirement Forms

1. Immunization Record Form
2. Immunization Waiver
   
   First Time Visit Forms

1. Patient Info Sheet
2. Medical History Form

Women's Health Form

1. Women's Health Exams Form

Insurance and Other Forms (Waiver and Enrollment forms may be found under the insurance tab)

1. Medical Record Release Form: To release or obtain a copy of your immunization records or any medical records, submitted to us, please download this form and mail or fax it to us. We will mail or fax your records within two days of receiving the request.
   Fall only Health Insurance Form: If you would like to remove the health insurance charge from your account for the Spring semester, the attached form needs to be completed.
   
2. Dependent Health Insurance Application Form: All students who want to enroll dependents in their insurance plan need to fill out this form.
3. Prescription Drug Claim form: Students needing to submit a claim for a prescription to the Insurance Company should fill out this form and mail it along with the pharmacy receipt to the address on the form. Please acc

Note: All Forms are in .pdf format. Click here to obtain Adobe PDF file reader.