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Forms & Resources

Health History Information

You must complete your health history, immunizations & meningitis information, and a brief family health history via the Student Health Services Student Portal by September 30th, 2012. This information is submitted through the Portal, and no physician signature is required.  Check the Student Portal page for additional information.

ADHD Forms

ADHD Forms & Pre-Appointment Document

Attendance Verification Forms

Attendance Verification (“Excuse notes”)

Events & Programming Forms

Health Promotion Services Program Request Form

Stressbusters Application Form

Stressbusters Event Request Form

Medical Leave of Absence (MLOA) Forms

 
Medical Leave of Absence policy

Undergraduate Request for MLOA (for students departing on MLOA)

Graduate Request for MLOA (for students departing on MLOA)

Undergraduate MLOA Request for Reinstatement (for undergraduate students returning from MLOA)

Graduate School of Arts and Sciences MLOA Request for Reinstatement
(for graduate students returning from MLOA) 

Authorization for the Use and Disclosure of Protected Health Information Form (for students returning from MLOA)

Mental Health Parental Consent Form

Consent to Treat (when student is not yet 18)

Prescription Forms

Prescription Transfer Form

Release of Information Forms

Release of Information Form

Sexual Assault Forms

Anonymous Report of Sexual Assault/Rape​​

Consent Form

Authorization for Medical and Mental Treatment and Financial Responsibility