Refusal of Care Against Medical Advice - University Health Services 2026

1. Click ‘Get Form’ to open the Refusal of Care Against Medical Advice document in the editor.
2. Begin by reviewing the criteria for refusing care. Ensure you meet all conditions, including being over 18 and having a clear understanding of your medical situation.
3. In the Acknowledgement of Information section, initial next to either option (a or b) that reflects your understanding and decision regarding medical care.
4. Proceed to the Release of Liability section. Initial here to confirm that you are releasing University Health Services from any liability related to your refusal of care.
5. Sign and date the form at the designated areas, ensuring all information is accurate before submission.
6. If applicable, have a witness sign and print their name along with the date in the Witness Information section.

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