Skip to Main Content | Skip to Left Navigation | Skip to Main Navigation
  • Home
  • Leeward Community College
  • UH System
  • About Us
    • About Student Health Center
    • Mission, Values and Vision
    • Patient Responsibilities
    • Notice of Privacy Practices
    • Contact / Location
  • Our Services
    • Appointments
    • Immunizations
    • Eligibility
    • Medical Records
    • Service Fees
  • Health Clearance Requirements
  • Student Health Insurance
    • UH Student Plan
  • Resources
    • Frequently Asked Questions
    • Forms and Brochures
  • Emergency Care
  • Resources
  • Frequently Asked Questions
  • Forms and Brochures

Home  >  Resources  >  Forms and Brochures

Forms and Brochures

  • Consent to Treat Minors (PDF)
  • Health Insurance Information Sheet (PDF)
  • Medical Exemption Form (PDF)
  • Release of Information Authorization Form (medical release) (PDF)
  • Religious Exemption Form for All Other Immunizations (PDF)
  • State of Hawaii Risk Assessment Questionnaire (PDF)
  • Student Health Center Brochure (PDF)
  • TB Document F: State of Hawaii TB Clearance Form (PDF)
  • VAX to School Flyer (PDF)

Leeward Community College Student Health Center
96-045 Ala 'Ike
Room AD-223
Pearl City, Hawaii 96782-3393 (map)

Phone: (808) 455-0515
Fax: (808) 455-0267
Email: leeshc@hawaii.edu


 

About Student Health Center
Our Services
Health Clearance
Student Health Insurance

Frequently Asked Questions
Forms and Brochures
Emergency Care

Contact / Location
Privacy
Site Index


University Health Services Mānoa is a department in the Division of Student Success at the UH Mānoa.
©2004-23 Leeward Community College Student Health Center / University Health Services. All Rights Reserved. Read Disclaimer.

Last Modified: September 26, 2022   ||   *PDF files require Adobe Reader
Leeward Community College  |  UH System