General MIT Health Forms and Documents
Health history forms
Medical record forms
- Authorization for Release of Protected Health Information (Medical Record) to MIT Health
- Authorization for Release of Protected Health Information
(Medical Record) by MIT Health - Authorization for Release of Protected Health Information
(Dental Record) by MIT Health - Request for Amendment of Protected Health Information
Patient privacy / advocacy / rights
Student health forms
- Student Medical Forms Information
- Student Medical Report Form
- Varsity Student Athlete Physical Examination Form
- Student Vaccine Exemption Form
- Student Tuberculin Requirement Form
- Information about Meningococcal Disease, Meningococcal Vaccines, Vaccination Requirements and the Waiver for Students at Colleges and Residential Schools
Pediatric care forms
- Consent for treatment of a minor (parental consent allowing another specific adult(s) to authorize medical care for a child in the parent's absence)
- Pediatric Health History
- Massachusetts certificate of immunization
- Massachusetts school health record form
- Massachusetts school immunization requirements
Wellness class registration
Class registration (Community Wellness at MIT Health)