Important Forms

health and counseling forms.

Academic Screening Packet (ADHD and Learning Disabilities)

The academic screening packet must be completed before a psycho-educational assessment.

Consent to Treat

In the state of Nebraska, the age of majority is 19 years old. If you are under the age of 19, your parent will need to complete this consent to treat form and return it to our center. The form can be emailed to our front desk staff or faxed to 402.280.1859.

Immunotherapy Agreement Forms

To begin immunotherapy (allergy shots), complete this immunotherapy patient agreement form and have your allergist complete this immunotherapy medical provider agreement form.

Power of Attorney

The power of attorney form, to be signed and notarized by a parent or guardian, allows students regardless of age to give consent for their own health care in our center.

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 at Student Health Services or have this tuberculosis provider review form completed by an outside medical provider.