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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 Medical Information 8-22-16

Form 41 Authorization to Consent to Treatment of Minor 03_2016

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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