Forms & Policies

Leave of Absence

Undergraduate students seeking a leave of absence for health reasons can find more information at the Dean of Students Health Leave of Absence page. Students seeking a leave of absence for other reasons can find more information at the Registrar's Leave of Absence and Withdrawal page.

Graduate students seeking a leave of absence should contact Dovev Levine, PhD, Assistant Dean for Student Affairs by email or by calling (603) 862-2234.

Medical Excuses

Individual medical excuses are not provided for students missing classes or exams due to illness. It is the student's responsibility to inform professors of illness or reasons for absence.


Confidentiality at Health & Wellness

Health & Wellness is committed to protecting the privacy and confidentiality of all patient/client health information. Our policies and procedures are in compliance with Federal and New Hampshire laws governing the safeguard of patient/client privacy.

All interactions with Health & Wellness are considered strictly confidential. All staff members must sign a confidentiality agreement prior to being employed at Health & Wellness.

If you have any further questions about confidentiality at Health & Wellness, please email us or call (603) 862-4557.


Forms and Notices

Patient Rights and Responsibilities

NH legislation requires that we provide each patient with a copy of the Patient's Bill of Rights and Responsibilities. You will be asked to read and acknowledge this document at your first appointment to Health &Wellness.

Notice of Privacy Practices

We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. Please review our Notice of Privacy Practice for additional information regarding the uses and disclosure of your health information.

Required Disclosures by NH State Law

Most information shared by health care providers and their patients or clients is privileged, confidential, and protected by the law,  though there are some exceptions. Please refer to these Required Disclosures by NH State Law. We adhere to NH state law in reporting information disclosed by patients/clients.

Release of Information Form

In order to comply with federal and NH state laws, you must fill out and sign our Release of Information form to release your protected health information to another person or organization. 

Please note that a fee may be associated with the processing of medical records requests. If you are a current student or employee of the University, you may access your medical records yourself through the MyHealth&Wellness patient portal.

Permission to Treat Underage Student/Patient Form

If you will be under the age of 18 when you start in the fall semester, upload the Consent to Treat Minors Form to MyHealth&Wellness. Parent/legal guardian signature needed.