Forms & Policies
Health Record Requirement
For traditional Undergraduate Students:
Prior to entering California Lutheran University, completion of the Medical History form, Immunization History form, Meningitis Awareness form, Tuberculosis Screening Form and uploading your official immunization record is required of every undergraduate student and must be completed online at your student health portal.
The following vaccines are required of all incoming traditional undergraduate students:
- MMR (mumps, measles, and rubella): 2 doses
- Td/Tdap (tetanus/ diphtheria/ with or without pertussis): 1 dose within last 10 years after finishing the primary childhood series
- Hepatitis B: 3 doses
- Meningitis ACWY (such as Menactra or Menveo): one dose at age 16 years or older
Uploading an official immunization or vaccination record to the student health portal is required. If you do not have an official record, you may print out this Immunization Record form and have your health care provider complete and sign it.
Patient Privacy
We provide confidential health care which respects the privacy of an individual's medical information. In certain specified cases, Health Services may release your medical information without written consent.
Your Rights & Responsibilities
We are pleased to work with you to keep you in good health. We are available for advice on how to stay healthy and to assist you in getting well again if you are ill.
Consent Forms
- Authorization to Release Information From Health Services - Use this form if you would like Health Services to send any records from our office to another medical provider, clinic, school, organizaiton, or person.
- Authorization to Release Information To Health Services - Use this form if you would like Health Services to request information on your behalf from another medical provider that you have seen previously or another school that you have attended previously. Once received, the requested records will be added to your file at Health Services.
- Medical Authorization for Minors - Use this form if you are under 18 years old and need parental consent to receive medical services. Please note that certain services, such as those related to STD testing, family planning, contraception, pregnancy, and some mental health services do not require parental consent. If you have questions about whether you need parental consent to be seen at Health Services, please call our office at (805) 493-3225.