Bird Building
Cullowhee, NC 28723
828.227.7640 tel
828.227.7400 fax

Health Services Forms & Documents

Immunization Forms

Review the guidelines for completing immunization records and Obtain the immunization record form.

Guidelines for completing immunizations

Immunization record form 

Release of Information from Health Services

Complete a release of information to grant permission to Health Services to release your protected health information and medical records to the designee of your choice.

Authorization for release of information

Request for Records to be sent to Health Services

Complete this release of information request to grant permission to other medical providers or facilities that you would like to send your medical records to Health Services.

Authorization to request records

Parental Consent for Treatment

Use this consent form to grant permission to Health Services providers for patients that are minors.  This form should only be needed upon request of Health Services staff at the time of treatment.

Consent for Treatment


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