Forms

Attention newly admitted students: The following immunizations form and health history must be printed, completed, and returned to the health center before you can register for classes. You may submit the immunization information online or print out a copy to be sent to Hendrix Clinic and Counseling Center. Please keep a copy for your records.

Required Prior To Registering For Classes: 

• Online Immunization Form 
• Immunization Records For Students Attending MSUM 
• More Information On Immunizations 

Other Forms: 

• Authorization & Request For Release Of Medical Information 
• Authorization & Consent For Treatment Of Minors 
• Allergy Information & Forms
• Release of Health Information  
• Request to Obtain Health Information From Another Facility 

Requesting Health Information?
If you request a copy of your health information to be given directly to you, there may be a charge based on the number of pages copied. There may also be a charge for records sent to insurance companies or legal offices.

Fax Number
218.477.5867

Mailing Address
Hendrix Clinic and Counseling Center
1104 7th Ave South
Moorhead, MN 56563

Staff Only