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Florida Atlantic University - Division of Student Affairs

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EXPLORE STUDENT AFFAIRS STUDENT HANDBOOK

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General Documents & Forms

Authorization Forms

Authorization for Release of Medical Information from FAU

Print a blank form and then complete the form by hand.

Deliver the form to Student Health Services via one of the following methods:

Fax a signed copy to (561) 297-0494.
Mail a signed copy to:
Florida Atlantic University
Student Health Services
777 Glades Road
Boca Raton, Fl 33431
Bring a signed copy to the Student Health Services office.

Authorization for Release of Information to FAU

To have your medical records sent to FAU, print and complete the form and provide it to the provider in possession of your records. Please allow sufficient time prior to your appointment for Student Health to receive your records.

Brochures

Visit the Student Health Services office for a copy of our brochure, or download here.

Student Health Services Brochure

Immunization Forms

See our Frequently Asked Immunization Questions for more information about Immunization requirements.

Immunization Form

Immunization FAQs

Medical Health History Form

Note: If you have never been seen before in our clinic, you will need to print and fill out the Medical History Form and sign the Release to Treat section on the second page. Bring the completed form to your appointment.

Medical Health History Form

Advance Directives

We encourage students to review information about advance directives. If you already have advance directives in place, give a copy of them to your provider and they will be placed in your medical record at Student Health Services.

Find more information and other types of advance directive forms.

Consent Forms

Prior to receiving an immunization from Florida Atlantic University's Student Health Clinic, please complete the appropriate consent form for the immunization that you are receiving. Be sure to read the corresponding What You Need To Know Vaccination Information Sheet before signing the consent form.

Important:

If you are under the age of 18, your parent or legal guardian must also sign the consent form. Additionally, if you have never been seen before in our clinic, you will also need to fill out the Medical History Form and sign the Release to Treat section on the second page.

Hepatitis B

Vaccine Consent Form

Hepatitis B Vaccine:

What You Need To Know
CDC Publication date 7/18/2007

HPV

Vaccine Consent Form

HPV: What You Need To Know
CDC Publication date 2/2/2007

Influenza

Vaccine Consent Form

Inactivated Influenza Vaccine: What You Need To Know 2007-2008
CDC Publication date 7/16/2007

Measles, Mumps & Rubella

Vaccines Consent Form