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California State University, Long Beach
Student Health Services
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Student Health Forms

Form 04 Authorization for Release or Request of Information 08-09-17

Form 41 Authorization to Consent to Treatment of Minor 06-2017

Form 89 Immunization Requirements

Form 90 Tuberculosis (TB) Assessment

Advance Directives

Submit forms to Student Health Services in person, via fax or mail.

To fax health information please use this fax number:
(562) 985-1644

Mailing Address:

California State University, Long Beach
Student Health Services
1250 Bellflower Blvd., Long Beach, CA 90840-0201

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