Forms

Fillable forms are completed best on your computer with free Adobe software. If they are completed on your phone, they may not fill correctly.

Patient Forms

***Note: These forms will need to be completed each academic year.

• ***Medical History Form (PDF)
• ***Patient Information Form (PDF)

Annual Well Woman Exam

• GYN History Form (PDF)

Problem Female Exam

• Sexual History Form (PDF)

Sports Physical

• Preparticipation Physical Evaluation (PDF)

Other Forms

• Certificate of Immunization (PDF) (must be completed and signed by a healthcare provider)
• Consent for Medical Treatment of a Minor (PDF)
• CSU Privacy Notice Form (PDF)
• Release of Medical Information Form (PDF)
• Sexual History Form (PDF)
• STI Screen and Consent Form (PDF)