Health Center Forms

Student Health Record

If you have difficulty accessing the electronic forms in the Student Health Portal, please submit a hard copy of the Student Health Record form along with a copy of immunization records to our office. Any hard copy of information that you provide to Etter Health Center can be faxed to (717) 477-4042 or mailed to: Etter Health Center, Shippensburg University, 1871 Old Main Drive, Shippensburg, PA 17257.

Student Health Record Form

Student Release of Information Form

A student's health information is confidential under federal law. If a student would like to release his or her health information to a medical facility, or request information from a medical facility, a release form must be signed by the student and a witness.

Student Release Form

Pre-Travel Form

If you will be traveling internationally and need immunizations or medication to prevent malaria, you may make an appointment with our travel nurse. We do not keep the immunizations or medication for malaria at the health center but will give you the prescription so that you can pick them up at a pharmacy. Please click here to read more about Traveler's Health.

Pre-Travel Health Consult Form

Parent Release of Information Form

If a student would like his or her parent to be able to discuss their health information with health center staff, a release of information form must be signed by the student before any information is released to the parent.

Parent/Guardian Release Form