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Health Forms and HIPAA

​To access services at Student Health & Wellness Services students must
complete and bring the following forms to be seen for their initial visit.

*These forms are also available at Student Health and are completed upon arrival.

Please print and complete these forms to see a Medical Provider:
Health Insurance Portability and Accountability Act
General Consent to Treat and HIPAA

Please print and complete these forms to see a Clinical Psychologist:
AUDIT (Alcohol Use Disorders Identification Test)
Health Insurance Portability and Accountability Act
General Consent to Treat and HIPAA
PHQ-9
Psychological Counseling Contract​​

Additional consent needed for minors seeking medical treatment:
Please print this consent form, have your parent fill it out completely, and bring it with you.
Consent for Treatment of Minor - Medical

Student Health and Wellness Services  (714) 628-4773