Forms & Waivers
Please, read the following instructions to ensure a timely process. You can also visit our virtual lobby to schedule your appointment.
The Student Health Center will be available to meet via Zoom/phone Monday through Friday for currently enrolled students. If you are a new hire looking for a TB test, we will respond to your email within 24 hours Monday-Friday
Contact us: firstname.lastname@example.org
Prior to your first physical and mental health appointment, a health chart must be completed for each. See the links below to fill and sign the forms online using Adobe sign.
Prior to your first physical and mental health appointment, a health chart must be completed
for each. See the links below to fill and sign the forms online using Adobe sign.
After completing the forms, connect to our virtual lobby or send us an email to email@example.com and let us know that you completed the forms and you would like to schedule an appointment with a nurse or a therapist. Please, notify us if you need bilingual support (Spanish/English). You will be contacted by email/phone by one of our team-members to schedule your appointment. Please note: the phone number may appear as a blocked number. Be sure to provide the best dates and times to schedule your appointment.
The quickest way to schedule an appointment is by connecting to our virtual lobby or sending us an email to firstname.lastname@example.org asking to schedule an appointment for Mental Health Therapy or Nursing Consultation
(physical health). Or give us a call at (805) 546-3171, leave us a message and we
will respond to your call within 24 hours Monday-Friday.
*Please, make sure you have previously completed the online forms using Adobe sign.
Remember, forms for Mental Health appointments are different to Nursing consultation forms.
1. Visit our virtual lobby available on our website. You’ll have the opportunity to interact
with one of our team staff during specific hours.
2.Use the option to ask a nurse, also available on our website.
3. Check our health resources: We have compiled this collection of campus, community and online resources to help students find safe and reliable information related to health and wellness. Click the links on the left sidebar to take you to specialized information. Some links will take you to sites outside the Cuesta College web server and Cuesta College has no control over the content or availability of these sites.
4. Explore our Educational Repository: Digital, educational, communicative material to promote health and well-being among the Cuesta Community, or Follow us on social media on Instagram/Facebook @cuestahealthcenter for educational information, tips, advice, events and updates.
- Mental Health form:
If you would like to meet with one of our therapists, please complete and return all 5 sections (9 pages) of this form promptly and no later than 24 hours prior to your meeting time to avoid cancellation of your appointment.
After the form is completed and submitted, future appointments can be scheduled by visiting our virtual lobby.
- Nursing consultation form:
If you would like to meet with one of our nurses, please complete and return all 4 sections (8 pages) of this form promptly and no later than 24 hours prior to your meeting time to avoid cancellation of your appointment. After the form is completed and submitted, future appointments can be scheduled by visiting our virtual lobby.
- Other forms:
Telehealth services Form // Consent to receive TeleHealth services with the Student Health Center (SHC) staff and providers.
"Consent for Minors" Waiver // If you are a student and are under the age of 18 this waiver must be filled out prior to any physical or mental health appointments at the Health Center.
Authorization to Release or Disclose Patient Information // All appointments at the Health Center are confidential, however, if you would like to release information about your sessions and appointments to someone or an entity this waiver must be filled out.
"NEAT Intake" Forms// If you are scheduling an appointment with our Nutrition Education Action Team, please bring these forms filled out to the Health Center no later than 48 hours before your appointment. Print this permission form too.
Student Accident & Injury Report // In the event of an accident, injury or illness on campus, a student report must be submitted to the Student Health Center within 48 to 72 hours. The report should be filled out by the faculty or staff member who was advising the student during the time of the accident or injury before being turned into the Health Center. Once that report is submitted the student can begin to fill out paperwork for supplemental Student Accident Insurance at the Health Center.
Accident Reporting and Insurance // Cuesta College has limited supplemental Student Accident Insurance for injuries sustained during school-related accidents and activities. If you have other medical insurance coverage, all benefits under that policy must be fully utilized before the Student Accident Insurance policy applies. The Student Accident Insurance company will determine the eligibility of all submitted claims. It is the student’s responsibility to be evaluated, and fill out insurance paperwork at the Student Health Center within 72 hours.