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Forms SHC Forms

Medical work often requires forms. Below you’ll find descriptions of the most commonly needed or required forms for the Student Health Center. Many of our forms are now available for you to complete online at student health portal before your appointment. These online forms include the Personal Health History Form, Women's Health History Form, and Initial Psychiatric Assessment form. These forms must be completed online before your scheduled appointment.

Mandatory Immunization Form
University and the District of Columbia require that all students under the age of 26 show proof of the following immunizations:

1. One Tetanus and Diphtheria booster given within the past ten years
2. Two vaccinations against Measles, Mumps, and Rubella (MMR) given after age one and at least 30 days apart
3. Two vaccinations against Varicella (Chickenpox) given at least 30 days apart, or a history of Chickenpox verified by titer results           
4. Three vaccinations against Hepatitis B, dose 2 given thirty days after dose 1, dose 3 given four months after dose 2
5. One Meningococcal (Meningitis) vaccine for students living in residence halls

Meningitis Waiver Form
Student living in university-sponsored housing who do not wish to receive the meningitis vaccination can sign the meningitis waiver form stating they are aware of the risks of the disease and do not wish to be vaccinated.

Demographic and Contact Form (Only Available Online)
This form is filled out during your first visit to the Student Health Center to provide us with your preferred contact information.

Release of Medical Records Form
If you need a copy of your medical record, a Release of Medical Records form must be filed. This allows the Student Health Service to provide you or the health care facility of your choice the specified portion of your medical record. There is a fee for this service. The first 10 pages are $1 per page, anything over 15 pages is $15.

Women's Health History Form (Only Available Online)
This form is filled out prior to a routine gynecological examination.

Psychiatric Assessment Form (Only Available Online)
This form includes important information for the Psychiatric Nurse Practitioner about your health history.