Consent Forms for Student Health Services

Notice Of Privacy, Financial Agreement and Patient Rights AU Student Health

 

Psychiatric services consents

Psychiatric Services Consent - 18 years old and older

Psychiatric Services Consent - under age 18

 

Consent for Telehealth appointments

Telehealth Consent - 18 years old and older

Telehealth Consent - under age 18

 

in-person clinic visit - Minor

Minor Consent - under age 18 for an in person clinic visit

 

request for release of records

For release of records - (How to Complete form)

• • Select box next to Release of Medical Records TO  or Release Medical Records FROM
  • Once the appropriate box is selected, please complete the required information
  • Be sure to select the type of information to be sent

Release of Records Authorization(non-mental health)

Release of Mental Health Information