RUHS Forms

All forms are in Acrobat format.  If you do not have Acrobat Reader, it is available as a free download by clicking icon.

Pre-Entrance Immunization Record
**Must be completed by all students prior to enrollment.**

Undergraduate Student Form 
Graduate Student Form

Meningococcal Meningitis Consent for Immunization and Vaccine Information Statement

Health History

General Health History - For ALL students being seen for the first time.
Men's Health - For men coming for STI checks or with any urinary symptoms.
Women's Health - For women coming for gynecological exams, including routine tests (e.g. Pap smears) or problems (e.g. discharge).

Basic
Major Medical
Claim Reporting Form

Release of Information
Use these forms to have your doctor send your records to RUHS

Medical Record Release to RUHS

Last Modified 06/27/2006