Health Forms

Listed below are various Health & Counseling forms available for download; except where indicated, all forms are in PDF format. If you have any questions about any of these forms, please call Health Services at 585-245-5736 or Counseling Services at 585-245-5716.

Release of 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.

Authorization to Release Information

Please note that if you require a copy of your immunization or medical records, you will need to proceed to our Immunization & Records Requests page for more information. Students admitted prior to May 2004 and/or who require additional records should also see the Immunization & Records Requests page.

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 others requesting this information must also submit the online form below.

Verification of Student Absence

Policy for Students Receiving Allergy Injections--This form needs to be completed once per academic year.

Student Immunotherapy Contract

Minor Students Seeking Counseling--If you are under the age of 18 and seeking counseling services, you will need either provide parental consent OR document that your parents have refused/are unable to provide parental consent. The first form below is the Parental Consent Form; the second is the Minors' Consent Form.

Parental Consent Form
Minors' Consent Form

Incoming Students

For information about incoming student forms, please go to Health Requirements for Incoming Students. You may also wish to review the New Student Information page.