Forms

Following are forms the Health Center will need prior to being seen by any of its providers. Please download the forms you need, fill out, and bring to your first appointment.

Forms Needed for All Office Visits

Form / Document Title
Consent for Treatment
HIPAA Overview
Medical History
Minor Consent for Treatment

Additional Forms Needed for Gynecology Appointments

Form / Document Title
Gynecology Medical History
Family Pact Application
Consent Form for Birth Control
Using Contraceptives Successfully
What You Should Know About Contraceptives

Additional Forms Needed for Psychological Counseling Appointments

Form / Document Title
Consent for Counseling
Current Concerns

Miscellaneous Forms and Documents

Form / Document Title	Format	Format
Authorization to Obtain/ Release Medical Information	Word
Depo Provera Calendar (calculates dates)	Word
Emergency & Accident Procedures	Word	PDF
Assisting the Emotionally Distressed Student	Word
Preventing Violence	Word	PDF
Student Satisfaction Survey	Word
Campus Map		PDF