Covid Vaccine Consent Form
Prior to your scheduled vaccine appointment please print and complete the Covid Vaccine Consent Form. You will need to bring this form with you to your appointment.
Click to view Student Covid Vaccine Consent Form.
Click to view Faculty/Staff Covid Vaccine Consent Form.
Health Insurance Information Form
You may provide health insurance information to the Student Health Clinic prior to an appointment or if your insurance has changed. Please complete the Insurance Information Form and return along with a copy of your insurance card (front and back). Students: If you are 18 or older, make sure you sign the form.
Mandatory Health Requirements
Immunization to measles, mumps, and rubella (MMR) is a requirement for all students who attend UNI. To comply with this requirement, all students must provide records documenting proof of TWO measles, mumps, and rubella (MMR) vaccinations. Immunization dates must include month, day and year. We also must collect information on the status of student's vaccinations against meningococcal disease. Students can provide both the MMR and Meningitis vaccine on the Health Requirements Form. A photocopy of your immunization record should be attached to the Health Requirement Immunization Verification form.
Informed Consent for Behavioral Health Services
Students may view the informed consent used for behavioral health services at the health clinic. Click to view form Behavioral Health Informed Consent
Treatment of Minors
For students under 18 years of age, a parental or legal guardian authorization for medical treatment form must be on file in our office in order for you to receive prompt care and treatment should the need arise. Please complete and return the Consent for Treatment of a Minor (PDF) form
Request Medical Records
To request a copy of your health record, please complete and return the Consent to Release or Receive Medical Information or Consent to Release or Receive Mental Health Information (PDF) form. All information must be completed in order for your request to be processed.
* Please allow 48-72 hours from receipt of the signed release form for your health information records to be processed.
All Clinic forms can be faxed to the Student Health Center at: (319)273-7030.
