Below are the forms for immunizations as well as health consent forms.

Consent for Health Care Services (In-Person and Telehealth):

https://wellness.luc.edu/login_directory.aspx

*These forms only need to be filled out once.*

 

The following can be downloaded and printed for your use.

Required Forms for Incoming Students:

Immunization History Form (2020-21 Academic Year)

Other forms:

• Authorization for Release of Confidential Information
• Community Provider Report
• Minor Consent for In-Person and Telehealth
• Adult Consent for In-Person and Telehealth
• Wellness Center Patient Confidentiality Agreement
• Vaccine Medical Exemption Request form
• Advocacy Consent to Disclose (Release of Information Regarding Advocacy Services) 
• Allergy Injection Consent Form
• Consent to Record