Curry Health Center

Curry Health Center

Forms

REQUIRED FOR REGISTRATION

Immunization Requirement Form

RELEASE OF INFORMATION

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

CLASS EXCUSE: COVID-19

Please use the following form if your instructor requires an excuse from class and you are experiencing COVID-19 symptoms and must miss class:

COVID-19 Class Excuse

Feedback Form:  WE WANT TO HEAR FROM YOU!

Tell us the good, the bad, and the ugly.  We pride ourselves on serving students and we want to know if we're doing it well.

This form is anonymous to preserve your confidentiality. If you want to have someone follow up personally with you after you submit your form, please call 406 243-6076 and Laura Davy will have the appropriate staff member follow up with you.

 

* indicates a required field