Medical Forms

The following forms are .pdf files and require Adobe Acrobat Reader for viewing/downloading.
Get Acrobat Reader

Medical Report form -- Completed form must be returned to Health Service prior to enrollment. This form is sent to accepted students. If you have misplaced your form or need to fill out a new one, download the form, print and complete it for sending. This form lists the immunizations required for registering for classes and living in campus housing.

Release of Medical Information Authorization form -- Health Services will notrelease personal health information to any party without a student's writtenand witnessed release. The student’s signature must be notarized when the release is sent to us by mail or fax. When requesting copies or transfer of records fromtheir Health Services file, students must be specific as to dates, types ofinformation (i.e. entire record, lab reports, etc.) and receivingparty(ies). Completed release forms may be mailed or faxed to HealthServices. Please call the department for clarification, if needed.

Meningitis, Hepatitis B and MMR Immunization Clinic Information -- Maxim Health Systems will be collaborating with Embry Riddle Aeronautical University, Daytona Beach, to provide an immunization clinic for the prevention of Meningitis, Hepatitis B and MMR (measles/mumps/rubella) on. The costs of vaccinations will be $125 for Meningitis (Menactra), $65 for MMR and $85 for Hepatitis B (Hepatitis B is a 3 shot series and will be billed for each shot. The 2^ndshot is due 1 month later and the 3^rd, 5 months after the first.). Cash, Checks and Credit card payments will be accepted the day of the immunization clinic.