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Forms and Information

Following are links to the most commonly used forms. If you have questions or concerns, please feel free to contact us by phone (858) 534-3300.

Insurance Forms

Note, the Health Fee Waiver application is not available here. The waiver application is only available on-line through the Health Fee Waiver Tool in the TritonLink Toolbox. Read more ​about the waiver.​ Additional insurance forms can be found on their site.

Medical Records Forms

To request a copy of your medical records, complete and submit the ​Authorization to Release or Exchange Confidential Information form to our Medical Records Department. Our contact information is provided at the top of the form.

Miscellaneous Forms

  • Consent for Medical Treatment of Minors (PDF) — For ​any student under 18 years of age seeking health care. Have a parent/guardian sign it, and fax it to our Medical Records Department at (858) 534-7545. If you have questions, call Medical Records at (858) 534-2139​.
  • Notice of Privacy Practices — HIPAA (PDF) — Your rights and our obligations regarding the use and disclosure of your medical information in accordance with state and federal regulations.
  • Medical Excuses Note — Letter to Professors regarding student illness.

Optometry Forms

Optometry Patient History Questionnaire (PDF) — Print this f​​orm, complete, and bring it to your Optometry visit. If you have questions, call the Optometry Department at (858) 534-2602.​