To minimize your wait time at the Health Center, we have provided you with some forms to print and fill out prior to your appointment.
All files are in PDF format. You'll need Adobe Reader to view these files.
- Patient Authorization to Release Protected Health Information (PHI) (for faster processing, please fax form to (301) 314-9816)
- Prior to your first appointment at the Mental Health Service, go to myuhc.umd.edu and complete the questionnaires for your appointment (you must have an appointment scheduled in order to be able to complete the paperwork). Don't forget to click "SUBMIT" when you are finished. Please do not print the questionnaire and bring it to your appointment. If you are unable to complete this paperwork prior to your appointment, you can arrive 20 minutes early to your appointment to complete the questionnaire on one of our computers.
- Alcohol and Substance Abuse Screening Form
- Please read Notice of Privacy Practices
- Patient Authorization to Release Protected Health Information (PHI)
- Animal Handler Questionnaire
- Initial Asbestos
- Periodic Asbestos
- Respirator Physical
- Employment Physical
Vaccinia (Small Pox)
- About the University Health Center
- Health Insurance
- Frequently Asked Questions: Insurance
- Clinical Services
- Mental Health Services
- Health Promotion & Wellness Services
- Student Involvement
- New & Transfer Students
- CARE to Stop Violence
- Faculty & Staff Services
- For Parents