Forms

Student in Campus Health waiting room types onto cell phone

Forms for your first visit to Campus Health

Health History Form

Campus Health Medical Release of Information Form - to consent to sharing previous medical encounter details with Campus Health or transmit your Campus Health records. We cannot accept an electronic signature on Release of Information forms. All forms must have an original signature before the request can be processed. Requests for your records can take between 7-10 business days to process. If you only need copies of your immunization records, you can pick up those records by visiting the Health Information Management Department located on the second floor of the building and receive your immunization records during the same day. 

 

Forms for specific services at Campus Health:

IUD/Implant Insurance Form (Please call you  insurance company to determine benefits.  If you need assistance, please email insurancerep@unc.edu or call 919-966-6588)

Student Athlete Tryout Form

Travel Questionnaire

Request for Injection Allergy Therapy by Outside Provider Form

Yellow Fever Vaccine Questionnaire