If you are new to the Student Health Center and you want to save time checking in, fill out the New Patient Packet below, and bring it with you when you come in. IMPORTANT - PLEASE COMPLETE ENTIRE PACKET.

Questions filling out packet? call 970-351-2412

If you need a copy of your medical records, please fill out and return the form below.

Medical Records Release Form

You may fax your records release to 970-351-2427

To Parents: If your student is under the age of 18, you will need to provide a signed Consent to Treat Form prior to your student seeking care at the Student Health Center Medical Clinic. Please choose the link below to download this form.

Consent to Treat / Emergency Contact Information

Immunization Requirements: Per the State of Colorado Immunizations Law, all University students are required to show proof of Immunizations. Please submit your Immunization record to:

Student Health Services/ Immunizations Office
Campus Box 46
Greeley, CO 80639

email to:

Fax to: 970-351-3234 or 970-351-2427

Certificate of Immunization Form