Student Health Forms

• 01 Health History Consent for Treatment
• 04 Authorization for the Release of Information
• 15 Clearances only Measles Rubella Hep B Meningitis
• 28 Notice of Privacy Practices
• 41 Authorization to Consent to Treatment of Minor

Submit forms to Student Health Services in person or via mail. Locate SHS on the campus map.

To fax health information please use this fax number:
562-985-1644

California State University, Long Beach
Student Health Services
1250 Bellflower Blvd., Long Beach, CA 90840-0201