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CHC Forms

Students, please complete the New Patient Intake Form and the New Patient Information Form below if you have never visited the Campus Health Center and bring them with you on your fist visit. Your answers on these health intake forms will help your CSUMB Campus Health Center clinician understand your medical concerns and conditions better.

CHC New Patient Intake Form
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CHC New Patient Information Form
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The CHC Notice of Privacy Practices form below describes how students' medical information may be used and disclosed, and how to gain access to this information.

CHC Notice of Privacy Practices
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The Tuberculosis PPD form below should be completed by students who wish to request a Tuberculosis test. Students must bring this completed form when visiting the Campus Health Center.

CHC Tuberculosis PPD Form
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Campus Health Center

Phone
(831) 582-3965
Fax
(831) 582-3976