General Forms
- Medical History (pdf) - It is required that anyone using the CSU Health Network fill out this form. It can be filled out before you come in to save time.
- Immunization (pdf) - This form is required by all students to provide evidence that the student has the required immunizations.
- Authorization for Treatment of a Minor (pdf) - This form is required for patients under 18.
- Physical Therapy Department Brochure (pdf) - This brochure outlines the services provided by the Physical Therapy Department.
- Tuberculosis & Health History Instructions
- Tuberculosis Screening Form
- Tuberculosis Test Form - This form is to be completed with the assistance of a health care provider if deemed necessary by the Tuberculosis Screening Form.
Insurance Forms
- Insurance Claims Form (pdf)
- 2009 - 2010 Brochure (pdf)
- Replacement ID Card (pdf)
- Affadavit of Domestic Partnership (pdf)
- Request for Waiver (pdf)
- Insurance Appeals Form (pdf)
Immunization Forms
The following forms can be filled out online portal.hartshorn.colostate.edu or printed out and submitted to the above address.
- Tuberculosis Information Form (pdf)
- Health History Form (pdf)
- Authorization for Treatment of a Minor (pdf) - Required if the student is under 18 years or age.