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Student Health Services

Patient Forms

A full list of forms needed for the different services offered through Student Health Services. Some forms can be completed online using MyHealthSpace.

List of Forms

Some forms are also available online through MyHealthSpace, where noted.

Health History Form [PDF]

Fill out this form before your first appointment. Also available online through MyHealthSpace.

Medical Release Form [PDF]

Complete this form to release certain health records to an outside doctor, insurance company or family member. In accordance with the Open Notes Federal Rule Mandate enacted on April 5, 2021, a Medical Release Form is not required for information that can be found on MyHealthSpace.

Permission to File Insurance [PDF]

Complete this form to file an insurance claim with your provider. Also available online though MyHealthSpace.

Required Immunizations

You must enter and upload your immunization records to your MyHealthSpace account at Login is your UofSC network username and password, plus your date of birth. Once logged in, visit the "Medical Clearances" portion and click on "Immunizations Record". Enter your immunization dates and vaccine types for each vaccine received. Go to "Immunization Upload" to attach supporting documentation signed by a medical provider before orientation. (Note: You can take a photo of your documentation with your phone and upload the photo). You will not be able to register for classes until we have your required immunizations on file.

Notice of Privacy Practices [PDF]

Understand how your medical information is stored, who can access it and how it may be used or disclosed. Also available online through MyHealthSpace.

Treatment Agreement [PDF]

Complete this form to receive treatment recommended by Student Health Services health providers. Also available online through MyHealthSpace. 

Travel Clinic Questionnaire [PDF]

If you are planning to travel abroad, bring this completed form with you to your travel consultation with the Travel Clinic.

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