Forms

• Request for Medical Leave of Absence
  • Requests are submitted electronically through the Student Wellness Department. If your medical leave is being requested from a medical provider outside of the USD Student Wellness Department, please fax your medical records to the Student Health Center at (619) 260-2375. Once your medical records are received, your request will be reviewed.
• Returning from a Medical Leave of Absence Form
• Authorization to Release Patient Information
• Consent to Receive Services Form
• Parental Consent to Receive Services for Minors Form
• Tuberculosis (TB) Screening Questionnaire
  • The easiest way to complete the TB Screening Questionnaire is through your MyWellness Portal; however, if you are having difficulties accessing the TB Questionnaire in your MyWellness Portal, please complete the above form.

Submit your completed forms via fax or email to:

• Fax: (619) 260-2375
• Email: usdhealthcenter@sandiego.edu (not secure or preferred)

Please allow 72 hours for all medical records requests to be processed.