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. |
| 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