Forms

Immunizations

• Immunization form

Allergy

• Allergy form (For Patient)
• Allergy Informed Consent form (For Doctor)

HIPAA

• Accounting of disclosures request form
• Amendment and correction request form
• Authorization for release of Info with Medical Records
• Communication Accommodation Request Form
• Complaint Form
• Notice of Privacy Practices
• Restriction of Disclosures Request Form

International Students

• F1, F2 & J1, J2 Compliance Form

Medical Records

• Authorization to receive information
• Authorization for release of information
• Authorization for release of psychiatric information
• Authorization for visitor being present during the appointment

Student Health Insurance

• Enrollment Form - www.aetnastudenthealth.com. Type in UCF and proceed from there.

Wellness Center

Nutrition Information Intake Forms:

• Food Record Instructions
• Food Record Nutrition
• Peer Consultant Screening
• Nutrition History
• Weight and Eating Assessment

Biofeedback Program Forms:

• Instruction For Completing Biofeedback Program
• Perceived Stress Scale

Employment

• Wellness Peer Consultant Application
• Grad Senior and Wellness Peer Consultant (Returning)
• Application Reference Letter