Area Specific Forms

Purdue University Student Health Center (PUSH)

CAPS (Counseling and Psychological Services)

  • Authorization to Use or Disclose (pdf) | (doc)

Family Health Clinic of Carroll County

  • Authorization to Use or Disclose (pdf) | (doc)

Nursing

  • Record of Disclosure, Chlamydia Report (pdf) | (doc
  • Record of Disclosure, TB Report (pdf) | (doc

Urgent Care

  • Record of Disclosure, Animal Bite Report (pdf) | (doc

PUSH

  • Authorization to release ED Team (pdf) | (doc)