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. |
| Allergy Packet | |
| 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 | |
| TSpot Clinic Documents 2017 | |
| Off-campus TB SCREENING 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]
Mailing Address
Student Health Center
The University of Texas at Dallas
800 W. Campbell Rd., SSB43
Richardson, TX 75080