Student Health Forms
| Form Title |
|---|
| Authorization To Disclose Health Records (PDF) |
| F-1 International Insurance Waiver Form (PDF) |
| J-1 Visa International Insurance Waiver Form (PDF) |
| Privacy Notice Acknowledgement Form (PDF) |
| Medical History Form (PDF) |
| USA Student Health Privacy Notice (PDF) |
| Patient Demographic Form (PDF) |
| Rights of Patients (PDF) |
| Sexual Assault Anonymous Incident Report (PDF) |
| Tuberculosis and Immunization Form (PDF) - (Required before Orientation) |
| Please complete all other immunization and clinical forms via our Student Health Web Portal: http://studenthealth.sjzddclm.com |