Forms
Below you will find a comprehensive list of all forms and documents associated with the Health Center and its services.
Allergy
Athletics
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.
Gynecological Care Forms
Health Privacy & Medical Records
- Authorization to Release Protected Health Information
- Authorization to Release Protected Health Information (SUDS Only)
- Notice of Privacy Practices
- Notice of Privacy Practices (SUDS Only)
- Authorization to Release Dental Records
- Consent to Treat a Minor – See Immunization Form, Section D
- HIPAA Privacy Request Form
- Advanced Directives – (directs to third-party website)
Immunizations
Insurance Forms
- 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) (Español)
- Nondiscrimination Notice
Travel Clinic
- Pre-Travel Worksheet – Complete and submit PRIOR to your Travel Clinic Appointment