Forms are accessible on the Patient Portal upon scheduling your appointment with Health Services:
- Athlete Forms (print, complete/review) – please go directly to the UIS Prairie Stars website for updated forms
- Acknowledgement of Receipt of Privacy Notice (complete on Patient Portal under *Required Forms)
- Consent to Treat (complete on Patient Portal under *Required Forms)
- Notice of Privacy Practices (complete on Patient Portal prior to your initial appointment)
- Condom Request Form
- Gardasil/HPV vaccine consent form (pdf)
- Medical History (complete on Patient Portal under *Required Forms)
- Hepatitis A Vaccine Administration Record (pdf)
- Hepatitis B Vaccine Administration Record (pdf)
- Influenza Vaccination Consent & Administration Form 2021 2022 and Vaccine Information Sheet
- COVID-19 Vaccine Record Consent-UIS Maintain use of COVID-19 Vaccine
- Complete the Required Immunization Information on your UIS STATUS PAGE on your Checklist OR complete online in the Patient Portal under the Forms tab.
- Meningitis/Meningococcal Vaccine Consent Form
- MMR Vaccine Consent Form
- Presentation/Event/Co-Host Event Request
- Tetanus, Diphtheria and Pertussis Adult Vaccine Consent Form
- ALL Current Vaccine Information Statements (cdc.gov)
Consent Forms
- Authorization for Release and Disclosure
- Health Services Authorization and Consent for Treatment for Minors (pdf)
Gynecology Forms
- Women’s Health update (complete for each appointment between annual)
- Sexual History Questionnaire
- Contraceptive Consent
- Women’s Health Questionnaire
Student Teacher Form
COVID-19
- Check your COVID-19 vaccination record on new IDPH immunization portal
- UIS COVID-19 Vaccination Exemption Process
- UIS COVID-19 Vaccination Religious Exemption Request Form
- UIS COVID-19 Vaccination Medical Exemption Request Form
- World Health Organization COVID-19
Other Resources
- Counseling Center
- Graduate Assistant Time Sheet Form
- Health Care and Emergency Health Care Facilities in Springfield
- Exercise is Medicine on Campus
- UIS HS Student Affairs Immunization Policy 20-21
- Office of Disability Services
- Religious Exemption Protocol Form etc.
- Request Health Services to do a Presentation/Co-Host an Event
- Student Insurance
- Submit a question about the General Data Protection Regulation
- Undocumented Students – Resources for DACA and non-DACA recipients and their allies