University of Southern California
WE'VE MOVED - YOU WILL BE REDIRECTED IN TEN SECONDS.
OUR NEW ADDRESS IS:
http://ecohenshc.usc.edu

Forms

FOR PROCESSING OF YOUR COMPLETED FORMS: Please fax to (323) 442-6029 or e-mail to: ecohensh@usc.edu and call our Main Number at (323) 442-5631 during clinic hours to check whether we received it.

Surveys

In an attempt to become environmentally friendly and fully integrate our electronic medical record, we have implemented our surveys to be filled out on your MySHR via iPads in the waiting room.
All of our patients, both counseling and medical, will have the opportunity to fill out surveys on the iPad. Although all of our surveys are not electronic at this moment, we hope to reduce the amount of paper surveys as soon as possible.
Most of these surveys are not mandatory but are helpful to the physicians. If you feel uncomfortable taking these surveys on the iPad, you can either fill them out on your smart phone once you have been checked in, request to take your survey in the exam room [medical visits], or inform one of the medical assistants that you would prefer not to take the survey.
Please remember these surveys are confidential and are in place to help our medical staff better serve you.

Medical

HIPPA Privacy Notice
Flu Consent Form
Accessing Medical Services
Travel Clinic

Counseling

Counseling Intake Packet
Accessing Counseling Services

Health Information Management (Medical Records)

Medical Records Access Request Form

Insurance

Aetna Plan Document This is an Adobe Acrobat document.
Summer Registration Form
USC Eye Med Vision Care Services This is an Adobe Acrobat document.
Delta Dental Optional Student Dental Plan Benefits This is an Adobe Acrobat document.
Delta Dental General Info This is an Adobe Acrobat document.
How to print an ID card This is an Adobe Acrobat document.