Forms

Medical Information Forms*
*Note that patients can also request release forms via My Health At Vanderbilt 

• Advance Care Plan Form
• Appointment of Healthcare Agent Form
• Authorization for Release of Information from VUMC
• Authorization for Release of Information to VUMC 
• Immunization Requirements Forms for Incoming Students 
• Release of Medical Information with Occupational Health
• Revocation of Authorization Form
• Physical Exam Forms
  • Pap Test and HPV Information
• Pre-Travel Questionnaire

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)

Insurance Forms

• United Health/Optum Mail Order Rx Form
• United Health Claim Submission Form