Forms

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Consent Forms
In order to receive immunizations from the Yuba College Health Center, a consent form must be signed. Please read the accompanying What You Need to Know Vaccination Information Sheet (VIS) before you sign the form. If you are under age 18, your parent or legal guardian must sign the consent form as well. Furthermore, if you have not already completed the Medical Health History Form at the Health Center, you will need to do so. Please also remember to sign the Release to Treat section that can be found on the second page of the Medical Health History Form.

• First Aid Kit Refills
  
  
• First Aid Kit Refill Checklist
  
  
• Influenza Vaccine Consent Form
  Inactivated Influenza Vaccine: What You Need To Know
  CDC Publication date 5/24/2004 (Please link to form)
  
• Tuberculin Skin Testing Questionnaire and Consent Form
  
  
• Tuberculosis Health Questionnaire

If you are a PPD converter, please use this form to assist the Health Services Nurse monitor for symptoms of TB.

• Hepatitis B Vaccine Consent Form
  Hepatitis B Vaccine: What You Need To Know
  CDC Publication date 7/11/2001
  
  
• Measles, Mumps, and Rubella Consent Form
  Measles Mumps & Rubella Vaccines: What You Need To Know
  CDC Publication date 1/15/2003
  
  
• Meningococcal or Meningitis Consent Form
  Meningococcal Vaccine: What You Need To Know
  CDC Publication date 7/28/2003
  
  
• Tetanus and Diptheria Consent Form
  Tetanus and Diptheria (Td) Vaccine: What You Need To Know
  CDC Publication date 6/10/94
  
  
• Medical Health History Form
  
  
• Records Release Form
  
  
• Notice of Privacy Practices: Acknowledgement of Receipt Form