Patient Forms

All New Patients:
If you are a new patient coming into the clinic for the first time, print, complete and bring the New Patient Packet with you to your appointment.
New Patient Packet (PDF)

Advanced Directive:
An advance directive is a written document in which people clearly specify how medical decisions affecting them are to be made if they are unable to make them, or to authorize a specific person to make such decisions for them. If you are interested in receiving a copy of an advanced directive, you may download it here or request one from the SHS front desk staff.
Advanced Directive (PDF)

Specialty Forms:
Print and complete these forms only if they are relevant to your appointment.
Reproductive Health form (PDF)
Parental Consent for Treatment of a Minor (PDF)
Alternate Parties Authorized to Consent for Medical Care for Minor (PDF)
Medical Records Request / Release (PDF)
Authorization for Disclosure Health Information (PDF)

These forms only apply to students who are required to show proof of insurance as a condition of enrollment.
Insurance Agreement
International Student Health Insurance Compliance (PDF)
Students in a mandated program with USF and eligible GA/RA/TA can enroll here.

All USF students are required to complete and submit the USF Immunization Medical History form. You can use the Online Record Submission to submit scanned immunization records.
Medical History Immunization Form (PDF)
Online Record Submission

Dietitian Appointment:
Complete the Nutrition Questionnaire before your appointment with the Registered Dietitian. Print, complete and bring the Food Log with you to your appointment.
Nutrition Questionnaire
3-Day Food Log (PDF)