E-mail this pageSports Medicine and Fitness Training Forms for Plattsburgh State
Note: these forms require the latest version of Acrobat Reader, which is available as a free download .
HIPAA Notice of Privacy Practices for Personal Health Information
This notice describes how your medical information may be used and disclosed.
- Download HIPAA Form (73.3kb)
Acknowledgement of Receipt of Notice of Privacy Practices
This is for students who have read the Notice of Privacy Practices form and understand it. Please read, print, complete and return to the Student Health Center.
Authorization for Use or Disclosure of Protected Health Information
Please read, print, complete and return to the Student Health Center.
Health Report
Please read, print, complete appropriate form and return to the Student Health Center.
- Download Domestic Students Health Report Form (72kb)
- Download International Students Health Report Form (130kb)
Contact Information
For more information about Sports Medicine or Athletic Training at SUNY Plattsburgh, please contact
Jason Pachter, Head Athletic Trainer
Office Location: Fieldhouse Training Room
Phone (AM): (518) 564-4152
Phone (PM): (518) 564-3089
E-mail: pachteja@plattsburgh.edu
Fax: Memorial (518) 564-2558
Field House (518) 564-2557