Forms

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
  • 2020-21 Pediatric Registration and Consent Forms: Read the registration packet requirements and review the Notice of Privacy Practices. Print pages 2-9 and complete the forms. Mail or bring the completed packet to a RAHS health center.
  • 2020-2021 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 2 a la 9, Ileneen los documentos.
  • 2020-21 General Consent for Healthcare - Child: Read and review the General Consent for Healthcare. Download and complete form using a laptop or desktop computer. It may not work on a mobile device.
    Instructions:
    • Download form
    • Save as Name plus Date of Birth of Patient (example: MariaSmith-5August2010)
    • Open saved pdf with Adobe Acrobat, not a web browser
    • Read the consent form
    • Check the boxes you agree with under “My signature represents the following”
    • Click above “Signature of Parent of Legally Authorized Representative” to add your digital signature
    • Digital Signature directions:
      • Click on “Configure New Digital ID”, then continue
      • Create a new Digital ID, then continue
      • Save to Windows Certificate Store, then continue
      • Type name and email address, then click Save
      • Click Continue
      • Click Sign
      • Save pdf
    • Check one box after “Relationship:”
    • Save completed form
    • Send to RAHSforms@med.umich.edu
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
  • 2020-2021 Adult Registration and Consent Forms: Read the welcome letter for registration requirements and review the Notice of Privacy Practices. Print pages 2-9 and complete the forms. Mail or bring the completed packet to a RAHS health center.
  • 2020-2021 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 2 a la 9, Ileneen los documentos.
  • 2020-21 General Consent for Healthcare - Adult: Read and review the General Consent for Healthcare. Download and complete form using a laptop or desktop computer. It may not work on a mobile device.
    Instructions:
    • Download form
    • Save as Your Name plus Date of Birth (example: MariaSmith-5August2002)
    • Open saved pdf with Adobe Acrobat, not a web browser
    • Read the consent form
    • Check the boxes you agree with under “My signature represents the following”
    • Click above “Signature of Parent of Legally Authorized Representative” to add your digital signature
    • Digital Signature directions:
      • Click on “Configure New Digital ID”, then continue
      • Create a new Digital ID, then continue
      • Save to Windows Certificate Store, then continue
      • Type name and email address, then click Save
      • Click Continue
      • Click Sign
      • Save pdf
    • Check one box after “Relationship:”
    • Save completed form
    • Send to RAHSforms@med.umich.edu
Notice of Privacy Practices
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.

  • 2020-21 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.