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Forms and Resources

OCC STUDENT HEALTH CENTER FORMS:
-print, fill out, and bring with you to your appointment.


OCC SHC Medical Intake Form (for all new patients; annually for returning patients)
Intakenewpatient_1.pdf

OCC SHC Mental Health Intake Form
Request_for_MH_counseling_t.docxRequest_for_MH_counseling_t.docx

OCC SHC Medical Records Release (releases information FROM OCC SHC TO you or another agency)
ReleaseofMedRecords (1).DOCReleaseofMedRecords.DOC

OCC SHC Medical Records Release (releases information from another agency TO the OCC SHC)
ReceiptofMedInfo.pdf

OCC SHD Female Health History (for all gynecology appointments)
FamPACTfemale.pdf

Consent for Treatment of Minors (not required for contraception, pregnancy, STI testing/treatment, or mental health crisis)
Consent_to_treat_minor.DOCConsent_to_treat_minor.DOC

 

Allied Health Students
History and Physical Form (patients new to the OCC SHC must print and complete the OCC Medical Intake Form as well, and bring it with you when you make your appointment)
AHPE_form_fall_2013.docxAHPE_form_fall_2013.docx


CA Family PACT forms
This is our OCC SHC program for sexually transmitted infection screening and birth control options.  All students must fill out the Contact Information, Enrollment Form, and the gender-specific History Form prior to their appointment.
 
Contact Information (all students)
Contactinfoallstudents.pdf
Enrollment Form (all students)
enrollmentallstudents.pdf
Female History Form (female students only)
FamPACTfemale_.pdf
Male History Form (male students only)
FamPACTmale_.pdf

ONLINE RESOURCES: 
Our newest student health resource is Student Health 101, an online newsletter that you can access by clicking on the following link.  Please take the "Wellness Assessment" on page 2 of the newsletter.

Student Health 101 Online Magazine

Take the OCC online alcohol assessment, and educational program specifically customized for OCC students: E-CHUG-2-GO:

Free Online Alcohol Assessment