Forms

 

Document Name Notes
CONSENT FOR TREATMENT OF MINOR WHO DOES NOT HAVE LEGAL POWER TO CONSENT (.doc) Students under the age of 18 must have a Consent for Treatment Form signed by parent or legal guardian. ALL FORMS MUST BE NOTARIZED AND MAILED TO THE STUDENT HEALTH CENTER.

Consent for Treatment Form PDF opens in a new tab

Consent for Minor (.doc)

Students over the age of 18 can consent to own medical treatment
You must be living apart from your parents or guardian and be managing your own finances
Authorization to Release Medical Records from UT Dallas PDF opens in a new tab The Student Health Center maintains a patient's medical records for 10 years from the date of last visit. Medical records are destroyed after 10 years.
Authorization to Release Medical Records to UT Dallas PDF opens in a new tab The Student Health Center maintains a patient's medical records for 10 years from the date of last visit. Medical records are destroyed after 10 years.
Bacterial Meningitis Vaccine Requirement Form PDF opens in a new tab To learn more, visit the Registrar's Vaccination Requirement page.
Patient Rights and Responsibilities PDF opens in a new tab  
TSpot Clinic Documents PDF opens in a new tab  
Health History Questionnaire PDF opens in a new tab 
Off-campus TB SCREENING FORM PDF opens in a new tab
 
Allergy Injection Policy PDF opens in a new tab
 
Allergy Injection Orders PDF opens in a new tab
 

 

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photo of students on campus

Contact Us

Student Health Center
Student Services Building 4th floor
SSB 4.700
972-883-2747 (office)
972-883-2069 (fax)
[email protected]

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Mailing Address
Student Health Center
The University of Texas at Dallas
800 W. Campbell Rd., SSB43
Richardson, TX 75080