Forms & Brochures
Health information services forms
- Release of Health Information from Yale Health
- Request to Send Health Information to Yale Health
- Designation of a Personal Representative to Access Health Information
- Mental Health & Counseling Records Release
OB/GYN forms
- Genetic Screening Form
- Instructions for 1 hour Glucose tolerance test
- Instructions for 3 hour Glucose tolerance test
- Ultrasound Instructions
Pediatric forms
- Child Health Record
- Health Assessment Record - CT Department of Education
- Early Childhood Health Assessment Record
- Authorization for the Administration of Medicine by School Personnel
- Sports Participation Health Record
- Youth Camp Health Exam/Record
- Yale Health Initital History Questionnaire
Travel forms
Other forms
- Comment Card
- Supplemental Claim Form
- ID Card Request Form
- Pharmacy Claim Form
- Mail Order Enrollment Form
- Retiree Major Medical Claim Form
- Acknowledgement Form Receipt of NOPP
- NOPP Notice
- Insurance Information Update Form (COB)
- Connecticut Advance Directives Information and Forms
Brochures
Patient Information
- Inpatient Care Patient Rights & Responsibilities
- Outpatient Care Patient Rights & Responsibilities
- Colonoscopy Prep Instructions
- Sigmoidoscopy Prep Instructions
