AVѧԺ

These forms can be printed out and filled in. If you are unable to open and print these forms, they are also available at the Health Center.

• Blood Chemistry Test Guide
• Health History Form
• Lipid Profile Test Guide
• Minor Consent for Treatment
• New Patient Data Form
• Personal Counseling Intake Form
• Release of Records
• Treatment of Minors Policy

There are no insurance plans associated with AVѧԺ. There is information available at the clinics about insurance plans available for purchase by students. It is strongly encouraged all students have their own insurance. Learn more about .

Students who are solely dependent upon prayer for healing and do not rely on medical services can apply for a Health Fee Waiver. You must provide an official letter from your church (on letterhead) verifying the information. Stop by the Health Center to pick up the form.

Your Rights

Everyone who receives care through Student Health Services at AVѧԺ has certain rights as a patient that we are responsible for providing:

• To be treated with respect and courtesy
• To have your condition and treatment explained in understandable terms
• To get a second opinion before making a medical decision
• To choose your provider or to request a change, no questions asked
• To privacy and confidentiality

All services rendered through Student Health Services are completely confidential. Your privacy is respected. Medical records are protected by law and cannot be released without your written permission, except under special legal circumstances.

Your Responsibilities

Everyone who receives care through Student Health Services at AVѧԺ has certain responsibilities as a patient:

• To provide complete and accurate information to the best of your knowledge about your health, medications including over-the-counter products and dietary supplements and any allergies or sensitivities
• To bring identification to verify current enrollment
• To be on time for your appointment (If you are more than ten minutes late, you may be rescheduled)
• To work as a team with our health providers to get well
• To accept personal financial responsibility for charges incurred
• To be respectful to all health care providers and staff, as well as other patients
• To call and cancel or reschedule your appointment if you cannot keep it