Forms

Document Name* Notes
New Patient Forms  
Consent for Treatment Form If not signed in the presence of and witnessed by Student Health Center staff, this form must be witnessed by a notary public.

Students under the age of 18 must have a Consent for Treatment Form on file with the Student Health Center in order to receive medical services.
Authorization to Release Medical Record Form 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 To learn more, visit the Registrar's Vaccination Requirement page.
Patient Rights and Responsibilites  
TB T-Spot Screening Clinic Forms  
TB Screening Documentation Form  

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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)
healthcen@utdallas.edu

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