Employee health forms

Currently, ASU Employee Health is billing departmental groups for ASU-required health screening and monitoring. For billing and insurance questions, email ASU Employee Health or call 602-496-1917.  

You have the right to expect the following from us: amend or submit corrections to your protected health information, be notified of a breach of unsecured health information, inspect and copy your protected health information, a printed copy of this notice, an accounting of how and to whom your protected health information has been disclosed, confidential communications concerning your medical condition and treatment, and to request in writing restrictions on the use and disclosure of your protected health information. ASU Employee Health will review all requests and typically respond within 60 days but is not required to honor all requests.

These forms are available to view and download:

  • Consent to treatment and privacy practices form.
  • Health history form.
  • Patient’s rights and responsibilities form.
  • Release of medical records form.