Student Health Services Forms


Medical Record Release Forms

All medical information is confidential and will not be released without written, informed consent. To obtain your medical information from Student Health Services, or to allow for your medical information to be sent to Student Health Services, please print, complete, sign and send the applicable form. Please include the ‘Cover Sheet’ with either release form to provide the necessary information. Requests for medical records require a minimum 3-5 business days to process. SHS will not send information to a non-encrypted email account. For students who have visited SHS, they are able to create a MYCHART account and view many of their own records.

Forms related to entrance requirements

  • Medical History, Physical and Immunizations Form (PDF) -This medical form is for new incoming students.   
  • Consent for Minors (PDF) -If a student is under the age of 18, this form must be filled out by a parent or legal guardian. 
  • Opt-Out Form (PDF) - If you, as a patient wish to not have Student Health Services share your health information with any Health Information Exchange (HIE) via the Care Everywhere electronic health record open access function, please fill out the form and send back to SHS.

External Travel Forms for Faculty and Staff

Media Center