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.

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.

Incoming Student Checklist--If you are an incoming student, please download this form to ensure that you have submitted all of the required information.
Physical Exam--If you are an incoming student, please download this form for your doctor's office to fill out.

Physical Exam

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

 

Religious Exemption--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

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

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.

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.