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

Telehealth Consent Forms:

https://forms.luc.edu/wellness

 

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
• Consent for Healthcare Services for Adults (updated 5-19)
• Consent for Healthcare Services for Minors (updated 5-19)
• Wellness Center Patient Confidentiality Agreement
• Advocacy Consent Form (Release of Information Regarding Advocacy Services) 
• Allergy Injection Consent Form