Forms and Information

Following are links to the most commonly used forms. If you have questions or concerns, please feel free to contact us by phone (858) 534-3300.

Insurance Forms

Note, the Health Fee Waiver application is not available here. The waiver application is only available on-line through the Health Fee Waiver Tool in the TritonLink Toolbox. Read more about the waiver. Additional insurance forms can be found on their site.

Medical Records Forms

To request a copy of your medical records, complete and submit the Authorization to Release or Exchange Confidential Information form to our Medical Records Department. Our contact information is provided at the top of the form.

Miscellaneous Forms

Consent for Medical Treatment of Minors (PDF) — For any student under 18 years of age seeking health care. Have a parent/guardian sign it, and fax it to our Medical Records Department at (858) 534-7545. If you have questions, call Medical Records at (858) 534-2139.
Notice of Privacy Practices — HIPAA (PDF) — Your rights and our obligations regarding the use and disclosure of your medical information in accordance with state and federal regulations.
Medical Excuses Note — Letter to Professors regarding student illness.

Optometry Forms

Optometry Patient History Questionnaire (PDF) — Print this form, complete, and bring it to your Optometry visit. If you have questions, call the Optometry Department at (858) 534-2602.

Resources

Emergency Care
Health Topics
Self Assessment Tools
Health Requirements
COVID-19
Patient Rights
Chaperone Policy
Parents & Families
Health Links
Videos
FAQ
Forms