On this page you’ll find: 

• Costs of services
• Intake forms
• Other primary care and behavioral health forms and resources
• Immunization and compliance forms and resources
• Confidentiality policy
• Chaperone policy
• Student medical leave of absence policy

Costs of services

• Costs of services chart
• Vaccine price estimates

Most Student Health and Wellness Center services are at no cost to students. However, the services listed below may not be fully covered by your insurance, and you’ll need to pay any remaining balance. You can check coverage amounts with your insurance provider: 

• Pre-entrance or travel vaccines
• Lab services
• Imaging
• Referrals to specialists
• Any care outside of the Student Health and Wellness Center
• Medications

It is your responsibility to ask about any costs before receiving services. 

Intake forms

Complete all intake forms before your appointment. 

Primary care intake forms

• New patient health history form
• Annual questionnaire

Behavioral health intake forms

Behavioral health intake form

For counseling appointments, fill out the sections of the form before the “STOP” sign.  

For psychiatry appointments, fill out the entire form. 

Behavioral health paperwork is confidential.

Integrative medicine and mindfulness coaching forms

• Massage intake form
• Mindfulness intake form

Other primary care and behavioral health forms and resources

• Release of information to OHSU form: Use this form to request medical records from outside clinics be sent to the Student Health and Wellness Center. 
• Release of information from OHSU form: Use this form to request Student Health and Wellness Center records be sent to outside clinics. 
• Consent to treatment form
• Informed consent for tele psychology
• GAD-7 form
• PHQ-9 form
• Travel patient questionnaire
• Controlled substance contract
• Alcohol and drug guide

Immunization and compliance forms and resources

• New student immunization requirements list
• New student immunization status form and instructions
• Returning student requirements
• Vaccine price estimates
• Vaccine resource list: Use this list to find health clinics outside of the Student Health and Wellness Center that offer vaccinations.
• Student Health policy 02-90-010: Eligibility, confidentiality and requirements

Chaperone policy

The Student Health and Wellness Center offers trained chaperones for sensitive medical exams. Chaperones are specially trained staff members. They’re here to offer you support and make sure you feel comfortable and respected during your exam or procedure. 

For more information, read our chaperone policy FAQ. 

Confidentiality

Any information you share during your appointment will be private. We won't share it with anyone outside of the Student Health and Wellness Center unless you give written permission or if it's required by law. 

The Student Health and Wellness Center operates separately from your academic and research programs. All electronic medical records are secure and non-Student Health and Wellness Center providers at OHSU cannot view any clinic notes. 

Our providers do not give grades or evaluate patients in any educational or training settings.  

For more information, read our confidentiality statement.

Leave of absence

• Request a medical leave of absence
• Information about returning from a leave of absence

COVID-19

Learn about COVID-19 vaccine information for new students.