Student Health Forms

Students entering the College of Osteopathic Medicine, College of Pharmacy or the JointProgram of Physician Assistant Studies/Masters of Public Health programs are required to complete the following Student Health Forms prior to matriculation. These forms will be used for all annual health requirements.  Incoming students must create a profile account  with CastleBranch.  Once a profile is created students must upload their completed forms along with all other health documents such as  immunization records, laboratory serum titers, PPD results or TB documents, and chest x-ray results to the Medical Document Manager in their profile 60 days after receiving their acceptance letter.  Please see the Entering Students Immunization & Health Requirements webpage for further information.


FORM A - Student Information

FORM B - Physical Exam and Health History

FORM C - 1  Initial TB Symptom Survey.  (Pre-Matriculation)

FORM C- 2  Annual TB Symptom Survey  (Previously Positive PPD Renewal Only.  


FORM F - Authorization for Release


"First Time Visit" Appointment Forms 

The forms are available on line,  or in clinic.  Please arrive few minutes before appointment to complete your forms.  

Illness / Travel / Medical Consultation / Appointments with the Nurse Practitioner. 

General Consent Form

Adult Medical History Form 


Other Forms 

Release/authorization Health Information Form (to request copies of Health Information)


Urine Drug Screen Information 

Urine Drug Screen (UDS) Process: PDF Version

 1.      Download the Urine Drug Screen Authorization Form and have a College Clinical Education or Clinical Experiential Representative Authorize the form.

 2.        Download the Urine Drug Screen Informed Consent Form.  Fill out the form entirely. You do not need to inform your college or the  Student Health Center of any Prescription Medication usage.

 3.      Turn in both completed forms to the Student Health Center via Email to , by fax at (707) 638-5261 or hand delivery to the Health Center front desk personnel.  You will receive further instructions by email within 24-48 hours after your completed forms are received in the Health Center.

 4.      Elective Rotations:  Urine Drug Screens required for Elective Rotations are paid for by the student.  You do not have to use the school designated lab unless your site specifies you do.  You can verify this with your Site Coordinator and may be able to find an Urgent Care or Occupational Health Clinic who can complete the UDS and you can submit the results directly to the site and SHC (to update your records).  Make sure to identify the type of Urine Drug Screen being required of you. (ex: 5 panel, 9 panel, 10 panel or 11 + panel).  If you would like to use the school designated lab (or any other contracted/affiliated lab) you will be required to pay $55.00 UDS Fee (contact SHC for instructions on Market Place Payment database) and follow to Step 5.

 5.      Contact the school designated Lab to complete your Urine Drug Screen. Lab Information was provided to you via email from the Student Health Center.

Note:  Without completing Step 1 - 4 you cannot call the Lab Directly to complete the Urine Drug Screen.  If you go to the lab without completing Step 1 – 4 and receiving email instructions from SHC you will assume financial responsibility all Lab fees.

Note:  You will need to bring a valid ID to the Lab. Drink a normal amount of water and eat a normal meal at least 2 hours prior to providing a sample to avoid a dilute or concentrated specimen.

 6.      Alternate Lab Location:  If you cannot use the school designated lab location. You will need to request a location accommodation. The Lab will ask you the location preference and set up the contract to use another affiliated Lab. 

 7.      Positive or Out of Range Urine Drug Screen Results:  The Student Health Center is using a Medical Review Officer (MRO) of the company/Laboratory reporting the toxicology report.  This means when a drug shows up positive, the MRO will attempt to call you (the student) to discuss any prescription medications you may be taking.  If the MRO cannot contact you by phone within three days, a POSITIVE result will remain on the drug screen.  It will be returned to Student Health for the Nurse Practitioner to contact you.  Thus, it is extremely important that students who are taking prescription medications answer their phones when the MRO calls to discuss the UDS report.

 8.      The Urine Drug Screen Results will be released directly to the Student Health Center by the lab usually within 72 hours of collection.  A copy of the cleared UDS will be provided to your school’s designated person (ex: COP experiential team, COM Clinical Education dept., PA Clinical Coordinator).  Positive or Out of Normal Range Results could be delayed depending on the MRO clearance process.

Request for Urine Drug Screen Forms