Health Services Forms
Medical Report Form
This form is sent to accepted students. A completed form must be returned to Health Services prior to enrollment. You may download the form, print it and complete it for sending. Proof of Required immunizations will be required to be in compliance with the State of Florida and ERAU.
Please note: There will be a medical hold placed on your student account until this information has been completed, and immunization requirements have been met.
Release of Medical Information Authorization Form
Health Services will not release personal health information to any party without a student's written and witnessed release. The student's signature must be notarized when the release is sent by mail or fax.
When requesting copies or transfer of records from their Health Services file, students must be specific as to dates, types of information (entire record, lab reports and so on) and receiving party or parties. Completed release forms may be mailed or faxed to:
ERAU Health Services
600 S. Clyde Morris Blvd. Building 20
Daytona Beach, FL 32114-3900
Fax: 386-226-6082
Immunization Waiver
Florida state law requires students who live in University-managed housing to provide written, physician-certified documentation for the Hepatitis B series (three doses) and Meningococcal Meningitis (single dose) or sign a waiver to decline those immunizations. ERAU encourages you to know the dangers of not being immunized.
Help Prevent Hepatitis | Voices of Meningitis
ERAU Health Services encourages all students to be immunized. Should you decide to decline, there will opportunities throughout the year to begin receiving immunizations at our monthly sponsored clinics. ***FLU SHOTS*** Students and Employees who would like to obtain a seasonal flu shot can attend any of our sponsored immunization clinics to be vaccinated. Charges may apply depending on your health insurance provider.
Faculty, Staff & Employees...We're Here For You!
ERAU Health Services provides routine treatment and care to employees, faculty and staff of the Daytona Beach and Worldwide Campuses, who participate in one of the ERAU health insurance plans. Employees and their dependents (spouse and/or children ages 6 and older) are also eligible, if they are covered under the employee's health insurance coverage.
There will be a charge of $15.00 per office visit, but for your convenience, it will be charged to your payroll account. Walk-in visits are seen on a first come/first served basis. The last patient will be seen 15 minutes prior to closing. Appointments can be made by calling 386-226-7917.
Convenient, affordable care is closer than you think! Please allow our Health Care team to serve you!
Location: Wellness Center, Bldg 20 (located directly across from Doolittle Hall)
e-mail: dbhealth@erau.edu
