Forms

Immunization Forms

• Please see out Immunization Requirements page for more information and for the required forms.

Insurance Forms

• Prescription Drug Form

Medical Information Release Forms

Releases must be signed by hand.

• UHP Medical Services to Outside Provider
• Outsider Provider to UHP Medical Services 

COVID  Vaccine Diagnosis Letter Documentation

Letter to be completed by your primary care provider for students, who meet the Tier 1b criteria, who would be interested in receiving the COVID vaccine through UHP when it is available. Form can be submitted to our office by fax at 406-994-2504.

• COVID Vaccine Diagnosis Form

Note: All forms on this page are in Adobe PDF format.