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Bolton Health and Wellness Center Privacy/HIPAA (Health Insurance Portability and Accountability Act) Use and Disclosure Authorization PATIENT NAME: CELL OR EXTENSION # Please tell us how best to
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Start by reading all the instructions carefully. It's important to understand the purpose and requirements of the form before filling it out.
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Provide accurate and up-to-date personal information. This includes your name, address, contact details, and any other relevant details requested.
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Who needs Holton Health and Wellness?

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Students: Holton Health and Wellness may be required for students at Holton University or any educational institution affiliated with it. It ensures that the health and wellness needs of students are met and helps in creating a safe and supportive environment for their overall well-being.
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Note: The specific requirements and individuals who need to fill out Holton Health and Wellness forms may vary depending on the institution or organization. It is important to refer to the instructions and guidelines provided by your specific educational institution or employer to determine if you are required to fill out these forms.
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Holton Health and Wellness is a comprehensive health program designed to promote well-being and prevent illness.
All employees and students are required to file Holton Health and Wellness.
Holton Health and Wellness form can be filled out online or in person by providing relevant health information and completing all required sections.
The purpose of Holton Health and Wellness is to ensure the health and well-being of individuals in the community and to promote a healthy lifestyle.
Personal information, medical history, current medications, allergies, and emergency contact information must be reported on Holton Health and Wellness.
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