Forms
Using the RAHS Health Center is easy! Find the registration form you need below, complete it, and mail or bring it with you to the health center at your school, or the school nearest you. Registration packets are also available at each of the RAHS health centers. Please call to schedule an appointment in advance.Pediatric Registration and Consent Forms
- Pediatric Registration and Consent Forms: Read the registration packet requirements and review the Notice of Privacy Practices. Print pages 3-7 and complete the forms. Mail or bring the completed packet to a RAHS health center.
- Pediatric Registration and Consent Forms – en Espanol: Lean la Carta de Bienvenida para cumplir con los requisitos de inscripcion y revisen los documentos de Notificacion sobre Politicas de Privacidad de UMHS. Impriman las pagina 4 a la 10, Ileneen los documentos.
- Pediatric Registration and Consent Forms – Arabic
- Pediatric Registration and Consent Forms – Swahili
- Instructions for submitting forms online:
- Scan or photograph all pages of General Consent Form and Health History Questionnaire
- Save as Name plus Date of Birth of Patient (example: MariaSmith-5August2010)
- Include RAHS location patient will visit in your email message
- Send to RAHSforms@med.umich.edu
Flu Immunization Forms
- RAHS Flu Vaccine Consent Packet and Flu Vaccine Information Statement : Print, read, and complete the Consent Packet. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent for Immunization Services- Child : Print, read, and complete the Consent for Immunization Services form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent for Immunization Services- Adult : Print, read, and complete the Consent for Immunization Services form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent- Inactivated Influenza Immunization And Immunization Record : Print, read, and complete the Immunization Services and Immunization Record form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
Sports Physical Exam Clearance & Consent Forms
Print the two-page form. Complete and sign consent. Return the completed packet to a RAHS Health Center to schedule a sports physical appointment.
Adult Registration and Consent Forms
- Adult Registration and Consent Forms: Read the welcome letter for registration requirements and review the Notice of Privacy Practices. Print pages 3-7 and complete the forms. Mail or bring the completed packet to a RAHS health center.
- Adult Registration and Consent Forms – en Espanol: Lean la Carta de Bienvenida para cumplir con los requisitos de inscripcion y revisen los documentos de Notificacion sobre Politicas de Privacidad de UMHS. Impriman las pagina 4 a la 10, Ileneen los documentos.
- Adult Registration and Consent Forms – Arabic
- Adult Registration and Consent Forms – Swahili
- Instructions for submitting forms online:
- Scan or photograph all pages of General Consent Form and Health History Questionnaire
- Save as Name plus Date of Birth of Patient (example: MariaSmith-5August2010)
- Include RAHS location patient will visit in your email message
- Send to RAHSforms@med.umich.edu
Notice of Privacy Practices
- Notice of Privacy Practices - English: Confidentiality and security practices of UMHS and RAHS.
- Notice of Privacy Practices – En Español
Patient Rights and Responsibilities and After Hours Care
What you can expect from your school-based health center, as well as how to get help when the RAHS Health Centers are closed.
Additional Services for Minors
Please ask your health center about these services.
- Minor Consent for Confidential Services: Read and review the Notice of Privacy Practices (above). Read and review this Minor Consent for Confidential Services. Download and complete the form as directed by health center staff.