FORMS

Click Here for Medical History Form
If this is your first visit to Student Health Services, you will need complete the Medical History Form. If it has been over a year since you have completed a Medical History Form, we will need an updated history from you. For your convenience, you may print and complete the form ahead of time and bring the completed form with you to your appointment.

Click Here for Immunization Form  
The completed Immunization Form should be mailed, faxed or delivered in person to the address on the form. For more information, please visit the Student Health Services website here or phone (561) 297-0049.  

Click Here for Authorization for Release of Medical Information From FAU  
If you need copies of your medical records; you will need to provide your written consent in order for them to be released. Fill out the form above and submit it to the Student Health Services clinic by one of the following methods:

VISIT US AT SR 106  
FAX: 561-799-8691
or
MAIL:
FAU
Student Health Services, SR106
5353 Parkside Dr.
Jupiter, FL 33458

Click Here for Authorization for Release of Medical Information To FAU
At times, it is necessary for treatment, to request copies of your medical records from an outside doctor or facility. In order for us to obtain a copy of your records, your written consent is needed. Fill out the form above and submit it to the Student Health Services clinic by one of the following methods:

VISIT US AT: SR 106
FAX:
561-799-8691
or
MAIL:
FAU
Student Health Services, SR106
5353 Parkside Dr.
Jupiter, FL 33458

FAU Campuses: Boca Raton/Davie/Dania Beach/Fort Lauderdale/Jupiter/Treasure Coast Boca Raton Campus Danie Beach Campus Davie Campus Fort Lauderdale Campus Harbor Branch Campus Jupiter Campus Treasure Campus
 Last Modified 7/23/13