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Vanderbilt University Medical Center
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Student Health Center

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    • How do I get seen at the Student Health Center?
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  • Services
    • Acute Care
    • Allergy Shots
    • Ancillary Services
    • Eating Disorders Assessment
    • LGBTQI Health Care
    • Primary Care Services
    • Routine Immunizations
    • Sexual and Reproductive Health
    • Sexual Assault Services
    • Specialty Services
    • Travel Medicine
  • Immunization Requirements
  • Student Health Insurance
    • Requirements
    • Eligibility for Gallagher Student Insurance
    • Waiving Gallagher Student Insurance
    • Student Health Insurance Plan FAQ
    • Insurance Forms and Brochures
    • Referral Information- What is a referral and why do I need one?
  • Information for New Students
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Forms

Medical Information Forms

  • Advance Care Plan Form
  • Appointment of Healthcare Agent Form
  • Authorization for Release of Information
  • Release of Medical Information with Occupational Health
  • Revocation of Authorization Form
  • Physical Exam Forms
    • Pap Test and HPV Information
  • Pre-Travel Questionnaire
  • Request for Medical Information & Release Authorization

Forms for Students Working with Animals

  • Animal Allergy Questionnaire & IACUC Occupational Health Verification Form for Students Working with Animals
  • Animal Allergen Declination Statement  
  • Hepatitis B Vaccine Declination Statement
  • Rabies Vaccine Declination Statement
  • Requirements for Researchers (IACUC website)

 


Vanderbilt University Medical Center

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Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled