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.
- Age and Treatment Guidelines for INH
- Authorization to Disclose Medical Records
- Authorization to Speak to Parents (HIPPA compliance)
- Gynecologic History
- Health History
- Immunization Record for Registration
- Immunization Screening Questions for Vaccinations
- Immunization Waiver (requires MD/NP approval)
- Preventive Medications for Malaria
- Technique for Impregnating Clothing or Mosquito Netting with Permethrin Solution
- Travel Immunization Information
*The downloadable version of this document is provided in a Portable Document Format (PDF). To learn more about PDFs or to install Adobe Acrobat Reader, follow this link.
