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

Telehealth Consent Forms:

https://forms.luc.edu/wellness 

*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
• Wellness Center Consent for Health Services-Minor (10/20)
• Wellness Center Consent for Health Services-Adult (updated 10/20)
• Wellness Center Patient Confidentiality Agreement
• Advocacy Consent to Disclose (Release of Information Regarding Advocacy Services) 
• Allergy Injection Consent Form