To be seen at Student Health & Counseling Services, there are several forms that you are required to complete prior to your appointment. The medical receptionist may ask you to download the following patient forms below to fill out and bring in to your next clinic appointment.
Please remember that all documents require your signature in order for it to be a valid document.
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To obtain your medical records from another medical office or to obtainyour medical records from SHCS, this form must be completed. To obtain your Psychiatric Records: |
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If you are a student 17 years of age and under, a parental/guardian consent must be signed in order to be seen at SHCS. |
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For new patients, a health history form must be completed priorto your clinic visit in order to provide you with outstanding health care. |
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To clear your MMR and Hepatitis B immunization, this form mustbe completed and signed by your medical provider identifying thetype of vaccine given and the date it was given. If you have your vaccination card, you may bring it in to SHCS for clearance. |
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For patients who have never had a pap exam with us, this form mustbe filled out prior to the gynecological exam. |
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For patients who are coming in for their yearly gynecological exam,this is a short updated pap form that must be filled out prior to the appointment |
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For patients who are coming in for a refill prescription on their oral contraceptives, this is a short updated form that must be filled out prior to the appointment. |
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Informational handout regarding the pap exam. |
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Consent form for patients who are interested in starting ahormonal birth control and requesting a prescription at SHCS. |
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Contact information form for counseling patients. |
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Information form for counseling patients. |
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Consent for Counseling services. |
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If you are a student 17 years of age and under, a parental/guardian consent must be signed in order to be seen for mental health care at SHCS. |
