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Forms

To expedite your appointment, please complete the New Patient Intake Form.

The Earle Student Center staff require several forms to be completed in order for students to remain compliant while at Furman University. To see our general requirements of immunizations please review our Immunization Record and TB Form [PDF]. If you are unable to acquire original documentation regarding your immunization record, you may use this form, but it MUST be signed by your healthcare provider.

Students who have a particular medical or religious exemption will need to complete the Immunization Waiver Form [PDF] in order to be compliant with the university’s immunization requirements. If you already have an official form provided by your home state, religious organization, or healthcare provider, we can accept these forms. Please ensure that the form has a professional signature from either a religious affiliate or healthcare professional.

Many current and former students may need immunization records. TThese individuals must complete the Authorization to Disclose Protected Health Information [PDF]. When completed, please email this form to furmanstudenthealth@prismahealth.org.