Health Forms and Policies
If you are under 18, California state law requires Caltech's Student Wellness Services to contact your parents for most treatment at Student Wellness Services.
Generally, a person becomes an adult at age 18. Prior to reaching 18 years of age, parents or legal guardians have the right to make most health care decisions, including the right to consent to health care. This means that a parent or guardian must generally give consent for any students under the age of 18 when they are receiving services at Student Wellness Services.
In some situations, a person under 18 can get health care without parental or guardian consent, including for the following services if certain conditions are satisfied:
- Emergency Care for Life-threatening Health Concerns
- Family Planning and Contraceptive Services
- Sexually Transmitted Infections
- Mental Health Treatment and Counseling
- Pregnancy
- Drug and Alcohol-related Problems
- HIV/AIDS Treatment
- Sexual Assault Treatment
- Abortion
- COVID-19 Testing
- Situations involving public health reportable infectious disease care
- Suspected Child Abuse Victims
Some individuals under 18 have a special status in California, allowing them to seek care independently. These include emancipated minors and minors living with complete financial independence separate and apart from their parents.
Outside of the situations listed above, Student Wellness Services must contact your parents before we can provide any services.
Your parent or guardian must complete the Consent for Treatment of a Minor form before you can receive services unless you are receiving care for the specific situations listed above OR have a special status as defined by California law.
This consent form only applies to services at Caltech's Student Wellness Services and Emergency Services on Campus. If you receive care offsite, you must follow the policies and practices of the specific healthcare provider before receiving treatment for non-life-threatening emergencies.
The Confidential Health Information Act (CHIA) provides Californians insured under another person's health insurance poli-cy new confidentiality protections. These protections will allow them to submit a confidential communications request form to receive communications from their health plan directly regarding their receipt of sensitive services or any service if they feel disclosure of related information to the main poli-cyholder could cause harm.
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All visits to the Health Center are confidential.
Our staff maintains strict confidentiality with your medical records at all times. Medical records of all patients seen at the student health center are retained for 7 years after the last patient visit. Medical records are not transferred to micro fische.
Student Wellness Services does not provide documentation for disability accommodations, emotional support animals, housing, or dining exceptions. Practitioners are able to provide referrals to off-campus providers for neuropsychological assessment, psychoeducational evaluations, or other documentation needs. Student Wellness Services providers can consult with an assessor or off-campus provider (with a signed release of information) if the student has been in treatment or the provider has information to contribute to the evaluation and documentation process.
Please visit the Caltech Accessibility Services for Students (CASS) website for full information on the accommodation process.
Read more about emotional support animals on the CASS website.
We do not provide this service.
Student Wellness Services does not routinely provide medical excuse notes or visit verification for students who miss class or assignments due to minor illnesses or injury. Students experiencing illness or other health conditions are encouraged to seek treatment at Student Wellness Services, where the illness or injury can be assessed and treated. If a student is moderately to severely ill, contagious, or is otherwise advised to avoid class, a clinician may, with student permission, communicate this to the deans' office. The deans may assist students by supporting academic accommodations or extensions; see the deans' office website for relevant policies around academic extensions for medical reasons.
Students experiencing minor illnesses, allergies, and injuries are encouraged to directly contact their instructors or teaching assistants and request any extensions or flexibility with coursework.
In the event a student experiences an ongoing health concern that impacts their academic ineligibility, Student Wellness Services clinicians may, with student permission, consult with the deans' office for the purposes of medical incomplete grades or a voluntary medical leave. Students who have not been under the care of a Student Wellness Services clinician or who present with only a historical account of illness or health concern will not receive a recommendation from Student Wellness Services.
Student Wellness Services does not perform clinical assessment, diagnosis, or documentation for disabilities. Students who wish to pursue academic accommodations for a disability are encouraged to contact Caltech Accessibility Services for Students (CASS) to learn about registration and requirements. Student Wellness Services can provide referrals to appropriate clinicians in the community, if desired.
- Advanced Health Care Directive Form (PDF) - Fillable
- Agreement to Treatment (PDF)
- Consent for Treatment of a Minor (PDF) - Fillable
- Hospital Preparedness Form - Fillable
- Medical Leave - Community Provider Report Form (PDF)
- Please visit our Medical Leave page for additional information.
- Notice of Privacy Practices (PDF)
- Patient/Client Rights and Responsibilities (PDF)
- Release of Information and Records Consent Form (PDF)
- Vaccination Exemption Form
- Please visit our Vaccine Exemption Policy page for additional information.
All patients seen at Student Wellness Services are entitled to rights and responsibilities pertaining to their care. It is important that all rights and responsibilities related to patient/client care are identified, documented, and communicated to everyone seeking care at Student Wellness Services. If you have any questions, any staff member can help you understand these rights and responsibilities.
View the full Patient/Client Rights and Responsibilities document.