Forms
All of the forms below can be completed online and then printed. When completing by hand, please use black ink. This allows for a clearer image when scanned.
- Absence Excuse (PDF)
- This form can be used to explain an absence from class due to illness.
- Allergy Injection Consent (PDF)
- Informed consent for administration of allergen immunotherapy.
- Administration of Allergen Immunotherapy (PDF)
- The completion of this form by the patient's doctor/allergist is required before allergy injections can be given at the Wilce Student Health Center.
- Animal/Biological Agents Contact and Use (PDF)
- Complete this form to provide your individual health history to Preventive Medicine.
- Annual Tuberculosis Evaluation (PDF)
- Complete this form if you have a reported history of a positive TB skin test.
- Dental Medical History (PDF)
- All new dental patients are asked to complete this form prior to their first dental appointment at the Wilce Student Health Center.
- Food and Activity Log (PDF)
- Complete this form prior to your first nutrition appointment.
- Medical Records Release Authorization (PDF)
- Complete this form to give permission to have your records released to the specified individual/business.
- Medical History (PDF)
- All patients are asked to complete this form prior to their first appointment at the Wilce Student Health Center.
- Nutrition Questionaire (PDF)
- Complete this form prior to your first nutrition appointment.
- Personal Pocket Medical History (PDF)
- This form can be used to keep track of your personal medical history.
- Pharmacy Dependent Access (PDF)
- Complete this form to register your dependent(s) so they can fill prescriptions at the Student Health Center Pharmacy.
- Physican Information Sheet (PDF)
- Information for physicians regarding allergy and other injections given at the Wilce Student Health Center.