This form must be completed at your first visit to UMKC Student Health and Wellness. The purpose of this form is to provide information on your medical history, current medications, allergies and family history — all of which is extremely important for both you and your health care providers to know.
Consent-Authorization for Release of Information Form
This form gives UMKC Student Health and Wellness permission to send, receive, or share your personal medical history. We will never share any of your medical records until we have received your permission.
Consent to Treatment of Minors Form
If you are under the age of 18, we are not able to treat you until we have this form completed by a parent or legal guardian.
This form states that you are permitting us to provide you care; it MUST be signed by you. Typically, you will sign this form electronically at the kiosk when you arrive for your visit; however, this form may be printed and used if our computer system is down.
Information on Human Papillomavirus (HPV)
This form is the application to apply for assistance on receiving the GARDASIL-9 vaccine.
