Patient Forms

To expedite the check-in process for your medical or mental health appointment, there are a variety of online/downloadable patient forms that you can complete prior to your appointment at the Health Center at Auraria. Depending upon the appointment you have scheduled will determine what forms you need to complete prior to the appointment. The Health Center at Auraria staff will notify you of the forms that you will need to complete for your specific appointment. In addition, there may be additional forms that will be completed while you are a patient at the Health Center at Auraria and will be completed in-person. 

 

New Patient Packet 
Complete this online new patient if this is your first appointment at the Health Center at Auraria. 

New Patient Packet

 

Protected Health Information
The Health Center at Auraria abides by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). All records are confidential and cannot be released to anyone without the patient's written authorization except when the record is subpoenaed by court order or required by public health law. Complete this form if you would like to request records for yourself or another facility.

Authorization for the Use of Disclosure of Protected Health Information

 

Immunization Compliance Form
Complete this form if you are a new student to CCD, MSU Denver or CU Denver. More information about the form can be found here.

Immunization Compliance Form

 

Nutrition Counseling Packet 
Download, print and complete this packet if this is you scheduled a Nutrition Counseling appointment.

Nutritional Counseling Intake Form

 

ADHD Patient Packet 
Download, print and complete this packet if this is you scheduled an ADHD appointment.

ADHD Diagnosis Treatment Policy and Forms

 


 

Miscellaneous Patient Forms

Transgender Resource List

Treatment of a Minor Parent/Guardian Consent Form


Make a Payment Student Employment