Forms

health and counseling forms

Academic Screening Packet (ADHD and Learning Disabilities)

The PDF iconacademic screening packet 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 iconconsent 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.

Power of Attorney

This PDF iconmedical 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 at the CHI Health Clinic – Student Care Clinic.

This PDF iconmental 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 at Student Counseling Services.

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 iconrelease 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.