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Students who have completed the following forms please email them to: healthservices@cabrillo.edu

COVID-19
COVID-19 Screening Questionnaire
COVID-19 Vaccine Minor Consent Form
COVID-19 Vaccine Accommodation Form
Authorization for COVID-19 Medical Information Release
New Client Mental Health Visit:
Acknowledgment of Privacy Practices and Consent for Treatment
Mental Health Intake Form
Annual Questionnaire
ACE Questionnaire
Alcohol screening questionnaire (AUDIT)
Drug Screening Questionnaire (DAST)
Mood Questionnaire (PHQ-9)
Establish Client Mental Health Visit:
Acknowledgment of Privacy Practices and Consent for Treatment
Annual Questionnaire
ACE Questionnaire
New Patient Medical Visit:
Acknowledgment of Privacy Practices and Consent for Treatment
Personal Health History Form
Annual Questionnaire
ACE Questionnaire
Alcohol screening questionnaire (AUDIT)
Drug Screening Questionnaire (DAST)
Mood Questionnaire (PHQ-9)
Establish Patient Medical Visit (seen 2016-2020):
Acknowledgment of Privacy Practices and Consent for Treatment
Annual Questionnaire
ACE Questionnaire
Other Medical Forms
Family Pact - Client Eligibility Certification (CEC)
Authorization for Release of Medical Information
Minor Consent Form
Release of Records
Physical exam for Allied Health Program
Other Forms
Presentation Request Form
Incident/Injury Form
Formularios en Español
Admisión de Servicios de Consejería y Salud para Estudiantes de Cabrillo College
Consentimiento para la vacuna de COVID-19 Para los menores de 18 años
Cuestionario bianual
Cuestionario de detección de alcohol (AUDIT)
Cuestionario de detección de alcohol (AUDIT - formulario rellenable)
Cuestionario de detección de drogas (DAST – Spanish)
Cuestionario De Experiencias Infantiles Adversas Para Adultos (ACE)
Reconocimiento de prácticas de privacidad y consentimiento para el tratamiento (próximamente)
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Locations
Aptos Campus
6500 Soquel Drive
Aptos, CA 95003
(831) 479-6100
Watsonville Center
318 Union Street
Watsonville, CA 95076
(831) 786-4700
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