Please complete the required forms listed under Medical Clearances in your Charger Health Portal or print out the forms below, complete, and bring to your appointment. Information (Demographics) Sheet Medical History Third Party Communications/Privacy Information Patient Rights and Privacy Notice FOR NURSING FACULTY ONLY - Annual Questionnaire for Employees with Positive TB Skin Test Billing: If you received a bill for services not covered by your insurance plan (or copay/deductible) or for past due accounts, you can choose to pay by: Credit Card or HSA/FSA card in the clinic or on the phone. Payments can be processed in the clinic Monday thru Friday, between 8am-11:30am or 1pm-4pm. Stop by or call 256-824-5495 or Payroll Deduction. If you choose the payroll deduction option, please fill out the top portion and forward to the Faculty and Staff Clinic. You can send the form to us by either: A secure message attachment using the billing/insurance option in your patient portal, or Drop off in person or by Campus Mail to UAH Health Services, Wilson Hall 327, or email to fsc@uah.edu