Insurance worksheet

• Do you know what your insurance plan covers, and where you need to go for care? Need information about co-pays and co-insurance? Use this worksheet to determine your coverage, including coverage of mental health and physical therapy treatments, and how much of the cost you’ll be responsible for.

UW International Student Health Insurance (ISHIP)

• Find ISHIP forms on the Lifewise Portal.

Graduate Appointee Insurance Program (GAIP)

• Find GAIP Forms and Information on the Lifewise Portal

Immunization requirement forms

• Visit the UW Immunization Requirement page for information and forms about immunization. 

Travel medicine

• The Travel Planning Questionnaire is for new patients seeking travel medicine at Hall Health.

New patient

• Pre-Registration Form for new patients to Hall Health Center. Filling out this form prior to your first visit can save time.
• Women’s Health History Questionnaire for new patients to the Women’s Health clinic or those who have not been seen for more than one year.
• The Travel Planning Questionnaire is for new patients to the Travel Clinic.
• Care Agreement (for patients who are under the age of 18)
• Financial Agreement
• Privacy Practices

Minors

Parents/guardians of students and other patients who are minors (under 18) will need to sign the following forms before Hall Health/UW Medicine can provide care:

• Care Agreement 
• Financial Agreement
• Privacy Practices

Print student name and student UW ID on form. Once complete, please have your student bring the documents with them to their first appointment or email your signed documents to uwhhc@uw.edu

Parents/guardians of students and other patients who are minors (under 18) will need to sign the following forms before Hall Health/UW Medicine can provide care:

• Care Agreement 
• Financial Agreement
• Privacy Practices

Print student name and student UW ID on form. Once complete, please have your student bring the documents with them to their first appointment or email your signed documents to uwhhc@uw.edu

When you have an appointment at the Counseling Center, you will be asked to show up 20 – 30 minutes early to fill out paperwork electronically.  In addition to a symptom checklist, you’ll find the forms below that we use if you want to preview them or have access to them at a later date:

Counseling Informed Consent And Financial Agreement

Initial Consultation Questionnaire

Additional Forms:

ASL Interpreter Confidentiality Statement

Authorization To Release Information Form

Crisis Services Referral Form            

If you have questions about any of our forms, or if you want to revisit prior authorization to release information, please contact us at 206-543-1240.

Health care directive & power of attorney

• A health care directive is a legal document allowing you to determine whether you would want your life prolonged if you had a terminal condition. Complete the Health Care Directive Form and bring it with you to your next appointment so that it can be added to your electronic health record.
• A durable power of attorney for health care is a legal document allowing you to name a person as your health care agent—someone who is authorized to consent to, stop or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself. Complete the Durable Power Of Attorney Form and bring it with you to your next appointment so that it can be added to your electronic health record.

Learn more about Health Care Directives and Durable Powers of Attorney from the Washington State Medical Association.

Form to request medical records or share medical information 

Read more about Release of Medical Information (ROI) and find the form you’ll need to give a parent, partner or other family member access to your medical record. You can also use this form to request medical records from Hall Health/UW Medicine.

New students who have not yet visited Hall Health or another UW Medicine clinic may upload a signed ROI form needed to grant access to medical information to a partner or family member here: Upload Documentation for Minor Students.