猎奇重口

the front enterance of the Curry Health Center on a sunny day surrounded by tree

Curry Health Center

Required for Registration

Immunization Requirement Form

Tuberculosis Screening Questionnaire

Release of Information Form

This is not a mandatory form.  Just complete if you need one of the following:

  • You seek care at Curry Health Center and need previous health records sent to Curry Health Center.
  • You want Curry Health Center to send your health records to another location.

Authorization for Release of Health Information

Authorization for Release of Health Information - ATC ONLY

Insurance Forms

All changes to insurance selections are now done through an electronic form located here: 

Signed forms are no longer required to be uploaded to the Patient Portal. Please request all changes via this electronic form. 

CLASS EXCUSE

Please use the following form if your instructor requires an excuse from class and you've had a minor resolved illness that does not need medical evaluation. 

Class Excuse Form

REQUEST FOR VACCINE ACCOMMODATION

Religious: If you are requesting a religious accommodation to the vaccine policy, please complete the following form and return to Curry Health Center staff:

Please note that this form must be signed in the presence of and stamped by a 猎奇重口 notary. Per MT State Law, we must keep the original form on file, thus digital reproductions/scans will not be accepted. Please return the original form to the Medical Reception Desk at Curry Health Center. This form also must be resubmitted annually for your accommodation to remain in effect. Please make sure to accomplish this well in advance of registration to avoid having a registration hold impact your ability to register on time. The laws governing this process can be reviewed . 

Medical: If you are requesting a medical accommodation to our immunization policy OR that of a partner organization (i.e., clinical rotation site), an attestation from your doctor will be required. The following must all be addressed: 

(i) attest that the physical condition of the person enrolled or seeking to enroll in school or the medical circumstances relating to the person indicate that some or all of the required immunizations are not considered safe; and

(ii) indicate the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization.

(b) The person is exempt from the requirements of this part to the extent indicated by the medical exemption statement.

(c) The medical exemption statement must be signed by a person who:

(i) is licensed, certified, or otherwise authorized by the laws of any state or Canada to provide health care as defined in ;

(ii) is authorized within the person's scope of practice to administer the immunizations to which the exemption applies; and

(iii) has previously provided health care to the person seeking the exemption or has administered an immunization to which the person seeking an exemption has had an adverse reaction.

Please deliver the necessary attestation to the Medical Reception Desk at Curry Health Center.