Forms
Document Name  |
Notes |
|---|---|
| Consent For Treatment Of A Minor Who Does Not Have Legal Power To Consent | 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 Consent for Minor To Own Treatment |
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 | 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 | 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 Responsibilities | |
| TSpot Clinic Documents | |
| Health History Questionnaire | |
| Off-campus TB
SCREENING FORM |
|
| Allergy Injection
Policy |
|
| Allergy Injection Orders |
.
Contact Us
Student Health Center
Student Services Building 4th floor
SSB 4.700
972-883-2747 (office)
972-883-2069 (fax)
[email protected]
Mailing Address
Student Health Center
The University of Texas at Dallas
800 W. Campbell Rd., SSB43
Richardson, TX 75080