Student Recreation and Wellness Center

Forms

The forms below are the ones students must complete on their first visit to the Student Health Center. Returning patients will be asked to complete a self check-in process, update contact information, and complete an annual health history.

Intake Forms

(Student has not been seen or used the SHC pharmacy within the last three years.)

We must provide a copy of the aforementioned documents to all students and document that a copy was given to them. Students will sign an acknowledgment for receipt of this form when he/she checks in at the SHC.

Immunizations

If your visit to the Student Health Center is for immunizations (vaccines), you will need to complete the intake forms listed above, in addition to the immunizations questionnaire and vaccination form below. (i.e. MMR, Td, Flu vaccine, Hepatitis B, Hep. A & B). If you are coming in for a TB (PPD) Skin Test, you will need to complete a screening form.

Additional Forms and Information