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Health and Counseling Forms

HEALTH FORMS


Authorization to Treat:

Authorization to Treat Form (1)revised513.docxAuthorization to Treat Form

 

Student Release Authorization:

StudentReleaseAuthorizationpdf.pdfStudent Release Authorization

 

Student Health Care Center Satisfaction Survey:

SHCPatientSatisfactionSurveypdf.pdfSHC Patient Satisfaction Survey 

 

Acknowledgment of Privacy Practices

PrivacyPracticesAcknowledgement.Revised.docxPrivacy Practices Acknowledgement

RAPcounselingnoticeofprivacypractices.docxNotice of Privacy Practices

 

Vaccination Refusal/Excemption Form
Vaccinate Exception.pdfVaccinate Exception


Travel Health Advisory Form

Travel Information_updated june 2015.pdfTravel Information


Student Medical Examination Record Form

Medical Form_Revied  JAN 2015.docxStudent Medical Examination Record Form

 

 

COUNSELING FORMS

 Student of Concern:

Student of Concern.docxStudent of Concern Form

 

Release of Information:

CounselingGeneralReleasepdf.pdfCounseling General Release

 

 

 

 

 

 

 

 

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