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• Hepatitis B and Measles/Rubella Immunization Form (PDF)
• Medical Information Release Form (PDF)
• X-ray Release Form
• Authorization for Disclosure of Protected Health Information to Parents/Guardians (PDF)
• HIPAA Privacy Notice (PDF)

Health History Form

• The Health History form needs to be filled out prior to your first visit at the Health Center. This form is available in the Health Center Portal.

Meningococcal Disease Response Form

• University Housing requires this form to be completed by all students living in on-campus housing. It is now part of the Health History form. To complete the Meningococcal Disease Response form, please log onto Health Center Portal and complete the pending Health History Form.
• Fall 2012 students: You will have access to the Health Center Portal AFTER August 20, 2012.

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Phone: 805-756-1111