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Authorization to Release Information Form
Release of Personal Medical/Health Information
This form grants the Health & Counseling department permission to share information with others, including health care providers, family members, Geneseo staff, and anyone else who you might designate.
Health Services Verification of Student Absence Form
Verification of Student Absence
Health Services will provide documentation of visits of the student to professors, employers, or others provided that the student signs an Authorization to Release Information. Professors and other campus personnel requesting this information must ALSO submit the online form below.
Verification of Student Absence (online form)
Incoming Student Forms
If you are an incoming student, please download this form for your doctor's office to fill out.
Physical Exam (PDF)
Minor Student Forms
Consent for Medical Treatment of Minors
If you are under the age of 18 you will need to provide parental consent for medical treatment.
Consent for Treatment of a Minor (PDF)
If you hold a deep religious conviction that prohibits you from participating in the routine vaccination program, you need to fill out the form and submit it as a waiver for the New York State required immunizations.
Religious Exemption (PDF)
Counselor Change Request
If you have been seeing a therapist in Counseling Services and would like to work with someone new (same academic year), print the form below, complete the requested information, and drop it off at Counseling Services, Lauderdate 205.
Counselor Change Request (PDF)