SHC

Forms and Documents

On this page, you’ll find useful forms and documents relating to health care at the Klotz Student Health Center. This information will be helpful for students who are under 18 years old when they attend CSUN, or students who would like a copy of their medical records.

Students can access and complete new patient forms including: SHC Acknowledgement of Fees, SHC Health History, SHC Notice of Privacy Practices and SHC Treatment Agreement though the myhealth patient portal.

CURRENT RELEASE OF INFORMATION GUIDELINES

If you are requesting a copy of your medical records, please submit your completed "General Consent to Disclose/ Release of Information" form (found below) with a copy of your photo ID to immunization@csun.edu. Due to limited staffing, please allow up to 7 to 10 business days for processing. For urgent requests, please call us at (818) 677-3666, Option 1. Please note, we do not release medical records via email.

Consent for Treatment of Minors

General Consent to Disclose/Release of Information

Academic Withdrawals for Medical Reasons

Medical withdrawals from the university are taken on a case-by-case basis. To ensure your medical withdrawal processes correctly, please contact the appropriate campus staff.

Undergraduate students

If you need to withdraw from classes for a medical reason, please contact the Office of Undergraduate Studies in University Hall 215 or call (818) 677-2969.

Graduate students

If you need to withdraw from classes for a medical reason, please contact the Office of Graduate Studies at (818) 677-2138.