Forms

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

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Allergy

• Allergy Packet

Athletics

• Pre-Participation Physical Form

Behavioral Health Clinic

• Behavioral Health Notification

COVID-19 Proof of Vaccination

• Fill out this form to verify vaccination status

Health Privacy

• Authorization to Release Protected Health Information
• Consent to Treat a Minor – See Immunization Form, section D
• Notice of Pricacy Practices
• HIPAA Privacy Request Form
• Advanced Directives

Immunizations

• UCF Mandatory Immunizations

International Health

• Travel Clinic Evaluation Patient Worksheet

International Student Insurance Forms

• Florida Board of Governors Requirements
• Gallagher Student Health Benefit Flyer for International Students
• Compliance Form
• Alternative Insurance List

Insurance Forms

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

Medical Records

• Authorization to Release Protected Health Information
• Authorization to Release Dental Records

Nutrition Information Intake Forms

• Nutrition History

Patient Rights and Responsibilities

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

Verification of Visit

• Verification of Visit Form

Women’s Care Forms

• Pap Smear Information Sheet