Forms to Complete Before Your First Visit

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Forms can now be filled out online in the Student Health Center Patient Portal.  Please go to and click on the FORMS tab.  You will need to comply with any form that requires an update prior to your appointment. You will need to call 310.243.3629 to make your appointment.

If you are a minor, please fill out the form below and submit it to our Dropbox link.

Student Health Services Forms - Dropbox

Other Forms

Please download, fill out and print the appropriate form before coming into the SHC, or submit to our dropbox.

Contraception Forms

Medical Records Request and Release Form

This form must be completed and submitted to our dropbox before any medical record will be released.  Our front office staff will contact you 3-10 business days after your request is submitted to advise of the status of your request.

Immunization Form

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