Please print out the necessary form(s). Then, complete all information in blue or black ink.
Release of health records; privacy practices
- Authorization for Release of Health Records (pdf)
- Notice of Privacy Practices Information and Acknowledgment Form (pdf)
Health history forms
- Faculty and Staff Health History (pdf)
To be used only by Cornell University employees.
- Report of Physical History (pdf)
If you are seeking a general physical exam, but do not have form to complete (e.g., for a potential employer, institution of higher education, etc.), use this form.
- Sports Clearance (directions and pdf)
This form must be completed by all incoming students who have been recruited as intercollegiate athletes.
- Travel Clinic History (pdf)
If you filled this form out via myGannett, you do NOT need to fill out a paper copy.
Department charge authorization
- Department Charge Authorization (pdf)
If your visit is to be paid for by a Cornell account, you must complete this form before your visit.