Forms

To electronically fill and sign a document, please open in Adobe Acrobat if prompted on the web page or download the document and open with Adobe Acrobat Reader. If your document requires multiple electronic signatures, you will be prompted each time to save the document after signing. Add your Last Name First Initial to the end of the file name (i.e. file-name-smith-j.pdf).
Filling out Electronic Forms
- COVID-19 Screening Form
- Authorization For Release of Medical Information
- Authorization For Release of Medical Information (for Drug/Alcohol; Mental Health; HIV/AIDs information)
- Certificate of Immunization
- Concern or Complaint Form
- Student Health History Form
- Insurance Form for Residence Hall Students
- International Student Insurance Waiver Form 2019-20
- Meningococcal Vaccine Response Form (Meningitis Waiver)
- Parental Consent for Treatment of a Minor
Location & Contacts
Brighton Campus
Flynn Campus Center
Bldg. 3, Rm 165
M - F 8:45am - 4:45pm
Phone: (585) 292-2018
Fax: (585) 292-3856
healthservices@monroecc.edu
Walk-ins are accepted.