STUDENT MEDICAL FORMS

Find the most common forms students need to receive medical care or disclose their immunization status to Seattle University.

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MOST COMMON FORMS

Consent to Release 

The Authorization to Disclose Health Care Information may be used to give consent for disclosure of your health records to the Student Health Center OR if you need records released from the SHC to another provider or clinic.  

Complete this form and return to the SHC by email, fax, mail, or in person. Please be aware that requests for information are processed in the order received and can take up to 2 weeks from the time received.  

Minor Consent to Treat 

For students under the age of 18 years old, a Minor Consent for Care for may need to be signed by a parent/legal guardian prior to services being provided at the Student Health Center. 

Immunization Record Verification by a Health Care Professional 

Immunization Record Verification HCP This form is not needed if you have acceptable documentation of the required immunizations but is an option. 

Immunization Exemption Request Forms 

Proof of measles immunity is required for the 23-24 academic year. If you have a medical or religious reason that prevents you from receiving a vaccination you may submit an exemption request to the Student Health Center. 

Immunization Medical Exemption Form

Religious Immunization Exemption Form