Forms

health and counseling forms

ADHD and Learning Disabilities Screening Form

ThisPDF icon screening form must be completed before a psycho-educational assessment.

Consent to Treat

If you are under the age of 18, your parent will need to complete this PDF icon consent to treat form and return it to our Student Counseling Services. The form can be emailed to our front desk staff or faxed to 402.280.1859.

Medical Exemption Form

Complete this PDF icon medical exemption form to request a medical exemption from a required immunization.

Power of Attorney

This PDF icon medical power of attorney form, to be signed and notarized by a parent or guardian, allows students who are 18 and younger to give consent for their own health care.

This PDF icon mental health power of attorney form, to be signed and notarized by a parent or guardian, is needed for students who are 17 and younger to give consent for their own mental health care.

Release of Information

To request a release of your personal health or counseling records to another healthcare provider, entity, or to yourself, you must fill out this PDF icon release of information form. This form must also be completed for our staff to communicate with other Creighton University employees.

Tuberculosis Provider Review Form

Students who are required by University policy to complete an annual provider review visit for TB screening, must have an appointment or have this tuberculosis provider review form completed by an outside medical provider.