Forms & Documents

Parent Forms

Parental Consent for Treatment and Care of Minors

Parental Consent for Treatment and Care of Minors

Print a blank form and then complete the form by hand. Deliver the form to Student Health Services via one of the following methods:

      • Fax a signed copy to 877-592-8688
      • Mail a signed copy to:
        Florida Atlantic University
        Student Health Services
        777 Glades Road
        Boca Raton, FL 33431
      • Bring a signed copy to the Student Health Services office

 

 

Patient Forms

Authorization Form

To have your medical records sent to FAU, print and complete the form and provide it to the provider in possession of your records. Please allow sufficient time prior to your appointment for Student Health to receive your records.

Authorization for Use or Disclosure of Protected Health Information

Print a blank form and then complete the form by hand. Deliver the form to Student Health Services via one of the following methods:

        • Fax a signed copy to 877-592-8688
        • Mail a signed copy to:
          Florida Atlantic University
          Student Health Services
          777 Glades Road
          Boca Raton, FL 33431
        • Bring a signed copy to the Student Health Services office
 Last Modified 3/28/19