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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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