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.
- Waiver Cancellation form (PDF)
- Exception to Closed Enrollment form (PDF)
- Electronic Medical Claims - sign up today! (PDF)
- No Show Billing Dispute form (PDF)
Medical Records Forms
- Authorization to Release or Exchange Confidential Information form (PDF) - To request a copy of your medical records, complete and submit this form to our Medical Records Department. Our contact information is provided at the top of the form.
Nutrition Forms
Miscellaneous Forms
- ELP Health Histroy 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.
Optometry Forms
- Optometry Patient History Questionnaire (PDF) - Print this form, complete, and bring it to your Optometry visit. If you have questions, call the Optometry Department at (858) 534-2602.