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Student Health Services Center Forms

Immunization Record Form

For use by ALL students. This form is completed and signed by the student ONLY. If the student is less than 18 years then the parent/guardian signs the form.

MMR Vaccine Information

Measles, mumps, and rubella (MMR) vaccine can prevent these diseases.

Medical Record/Physical Examination 2-page form

For use by students in health majors. The Medical Record page is filled by the STUDENT only. The Physical Examination page is Completely filled by the Healthcare Provider only.

Meningococcal Information

New Recommendations for Meningitis.

Permission to Release Immunization Records

This form is used to give permission to the Student Health Services Center to send your immunization records to another institution or facility.