Required for Registration

Immunization Requirement Form

Release of Information Form

This is not a mandatory form.  Just complete if you need one of the following:

• You seek care at Curry Health Center and need previous health records sent to Curry Health Center.
• You want Curry Health Center to send your health records to another location.

Authorization for Release of Health Information

Insurance Forms

All changes to insurance selections are now done through an electronic form located here: 

https://forms.office.com/r/1HBQAA35Vv

Signed forms are no longer required to be uploaded to the Patient Portal. Please request all changes via this electronic form. 

CLASS EXCUSE

Please use the following form if your instructor requires an excuse from class and you've had a minor resolved illness that does not need medical evaluation. 

Class Excuse Form

REQUEST FOR VACCINE ACCOMMODATION

RELIGIOUS: Please complete the following form if you would like to request a religious accommodation to a vaccine policy. 

Vaccine Accommodation Portal

MEDICAL: You may request a medical accommodation to a COVID-19 vaccine mandate required for a clinical placement.  You'll first need to have this paper form completed and signed by your HealthCare Provider, and then you'll need to upload the completed document to the electronic Medical Accommodation Portal linked above.