Forms
Health inventory and immunization records
All newly admitted students residing in student housing must complete the health inventory
and immunization form before arriving on campus. If you are a new incoming student
and have not been seen at Student Health and Counseling, please fill out the following
form. We will enter your information in our system to build you a record. New Patient Registration Form
Students can update medical information and print copies of their immunizations in the Patient Portal:
Consent for Release of Protected Health Information
The Release of Protected Health Information Form must be filled out for anyone over the age of 18 in order for the SHCC to release any protected health records, as stated in our Notice of Privacy Practices.
Counseling Intake Forms
Exemption forms
Request for an Appointment Form
This form is a request for SHCC staff to contact you to schedule an appointment. This form does not schedule the appointment.
(Must be currently attending classes to be eligible to be seen at SHCC, if there are questions, please call us at 907-474-7043.)
Guardian ÃÛÌÒÓ°Ïñ SHCC Consent to Treat a Minor
Students under the age of 18 need to have parents or legal representative fill out and return this form.
Summer SHCC Additional Fees Form (bridge fee)