Forms
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