Forms
Download, print, and complete the following forms as needed or when instructed to do so by Health Center staff. Forms are provided in PDF* format unless otherwise indicated.
- Animal Handler Health Risk Assessment (PDF)
- Authorization to Disclose Medical Records (PDF)
- Health History Questionnaire (PDF)
- How to Obtain Reimbursement From Insurance (MS Word)
- Immunization Record for Registration (PDF)
- Immunization Screening Questions for Vaccinations (PDF)
- Immunization Waiver (requires MD/NP approval) (PDF)
- Insurance Reimbursement Details (MS Word)
- Preventive Medications for Malaria (PDF)
- Release of Information to Parents (PDF)
- Technique for Impregnating Clothing or Mosquito Netting with Permethrin Solution (PDF)
- Travel Immunization Information (PDF)
- Treating Warts (PDF)
- Tuberculosis Screening Questionnaire (PDF)
- Women's Periodic Exam (PDF)
