Forms

Student Immunization Form 
ACU policy requires that all students enrolling for classes complete the student immunization form. This is to ensure the health and safety of our campus. Please follow the instructions on the form for completion and forwarding to the appropriate office on campus.

Authorization for Treatment of a Minor 
Any incoming student that is not 18 years old by the time he/she arrives on campus must have this authorization completed by a parent or guardian before the student can be seen in the clinic.

Authorization for Release of Clinical Record Information 
This form will need to be completed by the patient/student for the clinic to release information to another physician, agency, person unless otherwise authorized by law. If you have any questions on completing the form, please contact the clinic at 325-674-2625.

New Patient Registration
All new patients will complete these forms before being seen for the first time. This information will be updated annually during your visit. You may download and print these forms, complete them, and bring them with you to your appointment to expedite your visit.