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*Pound By Pound*

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About the Flu
(H1N1)

Your Health Center medical record is confidential, and access to it is limited to authorized personnel. Medical information may not be released to ANYONE; instructor, parent, or spouse etc., without written authorization from the patient, except as provided by law.

Please download and complete the appropriate forms and bring them with you at the time of your appointment.

Medical

• Consent for Treatment. PDF (Students)
• Comprehensive Health History. PDF (Students)
• Consent for Treatment. PDF  (Staff & Faculty)
• Comprehensive Health History. PDF (Staff & Faculty)

Screening/ Immunizations

• TB Consent Form. PDF (Students, Staff & Faculty)
• Influenza Form. PDF

Women's Health

• Oral Contraceptive Consent Form. PDF

Psychological

• Psychological Services Initial Intake. PDF
• Psychological Services Post Therapy Questionnaire. PDF

Chiropractic

• Personal History Form. PDF (Students, Staff & Faculty)
• Health Questionnaire. PDF (Students, Staff & Faculty)

Optometry 

• Eye Care Consent.PDF (Students, Staff & Faculty)
• Patient History Questionnaire.PDF (Students, Staff & Faculty)

Oriental Medicine

• Oriental Medicine Information Page
• Consent form.PDF (Students, Staff & Faculty)
• Patient Information.PDF  (Students, Staff & Faculty)
• Health Questionnaire.PDF (Students, Staff & Faculty)