Stephen F. Austin State University

Forms

Important Medical Forms

Medical History Form

Needed for your chart at your initial office visit. You may fill it out in advance and bring it to your first appointment.

Immunization Record Form

Used to document your immunizations or to review SFA's vaccination requirements. Your record does not have to be submitted on this form.

Allergen Injection Consent Form

Only applies to students who will have their allergy shots given at the SFA Health Clinic. Please read the Allergen Injection Policy first.

Medical Release TO SFA Form

Used to request that your medical provider(s) send your medical records to the SFA Health Clinic.

Medical Release FROM SFA Form

Authorizes SFA Health Clinic to send your medical records to another medical provider(s) at your request.

Consent to Treat Minor Student Patient

Applies to students under the age of 18.

Privacy Practice Policy Acknowledgement Form

Must be read and signed by all students seeking any form of medical attention at the SFA Health Clinic.