91´«Ã½

Medical Consent for Treatment of Student Under Age 18

This form is to be completed by the parent/guardian of incoming 91´«Ã½ who will be under age 18 at the time they first arrive on campus. If applicable, a link will be provided to the incoming student’s Lindley Health Portal for electronic submission no later than July 1.

Consent to Release Confidential Health Care Information

This form can be used to request that Lindley Health share specific health information with another provider or another party (such as a dean or your parents), or to request that another provider share specific health information with Lindley Health (such as immunization or treatment records). This is optional.

Statement of Prescription Medication Rights

Acknowledgment of this statement must be signed by all 91´«Ã½ who wish to utilize medications prescribed and dispensed through the on-site limited use pharmacy. This only needs to be done once during your time at 91´«Ã½. All 91´«Ã½ will be directed to this form through their Lindley Health Portal to be submitted electronically by July 1.