Forms and Documents
Parent/Guardian Forms
Parental Consent for Treatment and Care of Minors
Required for patients under the age of 18.
Patient Forms
Authorization for Use or Disclosure of Protected Health Information
To have your medical records sent to FAU or released by FAU, please complete this form. Allow up to 2 weeks for processing.
If SHS has referred you to Mantra Health, please complete this form.
Designation of a Health Care Surrogate
If you wish to designate a health care surrogate, please print and complete this form.
Feedback and Complaints
You may use the Feedback and Complaints form for:
- Compliments
- Suggestions
- Reporting a Negative Experience at SHS
- Requesting Corrective Actions from SHS
Immunization Form
Complete the Online Immunization Form
- All students must complete the demographic information at the top of the form and sign in Section D.
- Students under the age of 18 must also have a parent/guardian sign in Section D.
- Students born after 1956 must have Sections A and B completed by a physician if official immunization documents are not attached to the form.
- Students (or their parent/guardian if the student is under the age of 18) must sign in Section B if they do not have documentation of vaccination against Meningococcal Meningitis and/or Hepatitis B and elect to waive either or both of those vaccines.