Forms

New Student Health Forms 

Instructions for new undergraduate students about our required and recommended forms, visit our New Student Forms page.

Medical Releases 

• Authorization for Release of Protected Health Information
• Porter Medical Center Medical Records Release (Middlebury)
• University of Vermont Medical Center Medical Records Release (Burlington)

Medical Return Process  

• Leave of Absence - Medical Return Form
• Temporary Medical Leave - Medical Return Form

Minor Treatment/Consent 

• Consent Form for Treatment of a Minor

Exemption Forms and Documentation

• Undergraduate Vermont Colleges Vaccine Exemption Form
• NCAA ADD/ADHD Medical Exception Documentation
• Summer Student Measles Vaccine Exemption Form (Language Schools/BLSE)

College-Sponsored Health Insurance Forms (Gallagher/Wellfleet/Cigna)

• Prescription Override Form
• Medical Claim Form 

Vermont State Forms for Advance Directives/Health Care Agents (not required by the College)

• Vermont Department of Health: Create, Register, and Edit Advance Directive or Establish Health Care Agent