Medical Record Form
- Health Center Home
- Services & Fees
- Health Service Requirements
- Hours of Operation & Emergencies
- Staff
- Student Health Insurance
- The Plan
- Student Health
Insurance FAQ - Undergraduate Student Medical Record Form
- Graduate College and College of Continuing Studies Medical Record Form
- Meningitis Information
- Health Education
- Contact Us
All graduate and continuing education students are required to submit a completed confidential health history form in its entirety plus a record of immunizations upon admission to the University. Any student who has had a break in matriculation of two or more semesters must resubmit the same.
Faxed copies of the medical record form are not acceptable.
Please make a copy of medical form for your records.
Please make a copy of medical form for your records.
Download the Confidential Health History Form
Download links marked with the Adobe Acrobat logo require Adobe Acrobat Reader.
You can download Acrobat Reader for no charge by visiting
http://get.adobe.com/reader/.
