girl1

Forms you may need:

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Allows patients to indicate person(s) with whom information can be shared . Contactos Preferidos

Consent for Medical Treatment of Minor (PDF) - Allows parent(s) or legal guardian to authorize care for their minor child(ren) in their absence.

Student Fee Acknowledgement Form (PDF) 

All other relevant forms can be completed at the office in advance, before your visit. 

Please remember to bring:

  1. Your insurance card
  2. Valid photo ID
  3. LU Student ID
  4. List of current medications