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

Please 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. Please read more information about the waiver.

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.
Consent for Immunization of a Minor. 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 Forms

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