Forms

New Patient Forms

If you have never been to the Health Services clinic previously, please print, complete and bring the following forms with you to your scheduled appointment. We recommend that you arrive 15 minutes early to take care of registration and paperwork. Remember to bring your student ID and health insurance card. 

• Consent to Release Protected Information 
• Medical History form 
• Notice of Receipt of Privacy Practices 
• Consent to Treat a Minor form - If you are under 18 years of age, we’ll need written permission from a parent or guardian before we can provide medical treatment. Your parent or guardian can download the consent form and fax it to Health Services at 936.468.1316.

Medical Records Release Forms

• If you need to send your medical records TO SFA from another provider or facility, you’ll need to fill out the Medical Release to SFA form. 
• If you need to send your medical records FROM SFA to another provider or facility, please fill out the Medical Release from SFA form.