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Health and Consent Forms
- Health History Form - to be completed online at the Health Portal by all students and new patients.
- Notice of Privacy Practices (NPP) and Consent Form - to be completed by all students and new patients.
- Students or patients who have an FIT account must complete the form online at the Health Portal.
- Patients who do not have an FIT account must complete the NPP and Consent paper form (.pdf).
- Parental Consent Form - to be completed online at the Health Portal by parents/guardians of students under the age of 18.
Click here for information on immunization requirements.
- Immunization Form (.pdf)
- Meningitis Information Response Form (.pdf)
- Request for Religious Exemption to NY Immunization Requirements (.pdf)
Insurance and Prescriptions
- Aetna Medical Claims Form (.pdf)
- Aetna Prescription Drug Claim Form (.pdf)
- Aetna Medication Mail Order Form (.pdf)
- Aetna Dependent Enrollment Form (.pdf)
Medical Records Release Authorization
- Consent to Share Health Information between FIT Health Services and Counseling Center - available online at the Health Portal.
- Authorization to send records to FIT Health Services (.pdf)
- Authorization to send records from FIT to another medical office/facility (.pdf)