Consent Forms for Student Health Services


If you have questions to which form you need to complete please call (706)721-3448 or email: Student Health.

Notice Of Financial Agreement AU Student Health

Notice Of Privacy Practices 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