Health Enrollment and Consent Form
This Health Enrollment and Consent Form must be returned on or before the first day of class. The information you provide is confidential for use by the Wellness Center. It will not be released to anyone without your knowledge or written consent. This form must be properly completed and signed before you may receive medical care at the Wellness Center.
Use the download button below. This form can be completed and saved to your computer. The completed form can be emailed to firstname.lastname@example.org.