Forms

Forms

Immunization Information and Form

Immunization Appeal

  • Appeal period is now closed

Release of Information

A valid authorization signed by the patient is required to release any health information. Diagnosis of mental health, alcohol and substance abuse and AIDS/HIV are NOT included in a general authorization and must be indicated specifically on the release of information form. Please allow 24 - 48 hours process time for all releases. There is a cost to obtain personal copies. Please contact Health Services for more information 815-753-1318.

Student Insurance Forms

Exception To Reimbursement Policy - Medical Documentation

Housing & Dining Change Request for Medical Reasons

Students requiring special needs changes concerning dietary issues, room accommodations, etc., for a specified semester.

Parental Permission to Treat

Missed Appointment Fee Appeal Form