Forms and Information

​​​​​​​​​​​​​​​​​​​​Following are links to the most commonly used forms. If you have questions or concerns, please feel free to contact us by phone (858) 534-3300.

Insurance Forms

Note, the Health Fee Waiver application is not available here.  The waiver application is only available on-line through the Health Fee Waiver Tool in the TritonLink Toolbox. Read more ​about the waiver.​

• Waiver Cancellation form​
  
• Exception to Closed Enrollment form
  
• Electronic Medical Claims - sign up today!
  
• No Show Billing Dispute form
  

Medical Records Forms

• ​Authorization to Release or Exchange Confidential Information form​ - To request a copy of your medical records, complete and submit this form to our Medical Records Department.  Our contact information is provided at the top of the form.
  

​Nutrition Forms

• ​​ Dietary Assessment form​

Miscellaneous Forms

• ELP Health History form (pg.1) and ELP Health History form (pg.2)​​
• Consent for Medical Treatment of Minors - for ​any student under 18 years of age seeking health care. Have a parent/guardian sign it, and fax it to our Medical Records Department at (858) 534-7545. If you have questions, call Medical Records at (858) 534-2139​.
• Notice of Privacy Practices (HIPAA) - Your rights and our obligations regarding the use and disclosure of your medical information in accordance with state and federal regulations.
  
• ​Patient Rights and Responsibilities​

• Optometry Patient History Questionnaire - Print this f​​orm, complete, and bring it to your Optometry visit. If you have questions, call the Optometry Department at (858) 534-2602.​