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Forms

Below are the most common forms requested from Student Health and Wellness.

Consent for Treatment

Please complete this form online, print, put your original signature on the form and give to Student Health and Wellness staff for processing. Access this form here.

Release of Information

Please complete this form online, print, put your original signature on the form and give to Student Health and Wellness staff for processing. Access this form here.

Merck Patient Vaccine Assistance Programs

  • To find out the eligibility requirements click here.
  • Please print the from, complete Section 1, and bring the form and all required documentation to Student Health and Wellness. Your healthcare provider will complete Section 2 of the form. To access the form, click here.

Glaxo Smith Kline Patient Vaccine Assistance Programs

  • To find out the eligibility requirements click here.
  • Please print the form, complete Section 1 and 2, and bring the form and all required documentation to Student Health and Wellness. Your healthcare provider will complete Section 3 and 4 of the form. To access the form, click here