Please contact us at (914)323-7277 or email shac@mville.edu for an explanation of our forms or if you have questions about how to complete a form.
Health Forms
Consent Form for Treatment of Minors at SHAC- Exemption to Immunization Requirements
- Medical Leave of Absence
- Medical Leave of Absence Policy
- Provider Evaluation after Medical Leave of Absence
Counseling Forms
- Consent to Obtain Protected Health Information
- Consent to Release Protected Health Information
- Medical Leave of Absence
- Medical Leave of Absence Policy
- Policy for Treatment of Minors
- Treatment of Minors in Counseling (Consent Form)
- Provider Evaluation after Medical Leave of Absence
- Request to be a Referral to SHAC
- Student Health and Counseling Acknowledgement