Forms
Immunization Information and Form
State required immunization information and immunization form.
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.
Release of Information form (pdf).
Student Insurance Forms
Forms related to Student Insurance are available on the Student Health Insurance Web site.
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.
Housing & Dining Changes for Medical Reasons (pdf) (pdf).
Parental Permission to Treat
Missed Appointment Fee Appeal Form
