Forms

Below you will find a comprehensive list of all forms and documents associated with the Health Center and its services.

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Allergy

• Allergy Packet

Athletics

• Pre-Participation Physical Form

General Student Health Services

All of our departments and services information has been condensed into one single sheet, available to download and print for your convenience.

• One Pager – ENGLISH
• One Pager – ESPAÑOL
• One Pager – PORTUGUESE
• One Pager – ARABIC

Gynecological Care Forms

• Pap Smear Information Sheet

Health Privacy & Medical Records

• Authorization to Release Protected Health Information
• Authorization to Release Dental Records
• Consent to Treat a Minor – See Immunization Form, Section D
• Notice of Privacy Practices
• HIPAA Privacy Request Form
• Advanced Directives – (directs to third-party website)

Immunizations

• UCF Immunizations & Health History Form
• Requirements and Vaccine information

Insurance Forms

• Download/Print Application for Florida “No-Fault” Benefits
• Online Application for Florida “No-Fault” Benefits
• Medical Insurance Registration Form
• Standard Disclosure and Acknowledgement Form, Personal Injury Protection

International Insurance Forms

• FL Board of Governors Insurance Requirements for International Students
• Insurance Benefit Flyer for International Students
• Compliance Form
• Alternative Insurance List

Nutrition Information

• Nutrition History Worksheet – Complete and bring to your Dietitian appointment

Patient Rights and Responsibilities

• Patient Rights and Responsibilities – ENGLISH
• Patient Rights and Responsibilities – Español
• Nondiscrimination Notice

Travel Clinic

• Pre-Travel Worksheet – Complete and submit PRIOR to your Travel Clinic Appointment

Verification of Visit

• Verification of Visit Form