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Health Forms
Complete
these forms and bring them with you to your first visit at University
Health Services. With your health history and immunization
records on file, we will have up-to-date information to aid in your
care.
If you don't yet have a scheduled appointment, feel free to
complete these forms and mail them to us at:
Medical Records
University Health Services
Foust Hall 200
Mt. Pleasant, MI 48859
Pre-entrance Health History Report
Pre-entrance Health History Report (HS275A-R11/27/07)
Pre-matriculation Immunization Recommendations
Pre-matriculation Immunization
Recommendations (HS399-R1/11/07/-Immun-Rec)
Pre-matriculation Immunization
Record (HS275B-R12/07/07/)
Health Insurance Information/Consent to Treat Minor
HS275C-R11/27/07/)
Pharmacy Forms
Pharmacy Patient Registration Form
Pharmacy Patient Registration Form
(HS364A)
Pharmacy Delivery Authorization Form
Pharmacy Delivery Authorization Form
(HS366A)
Pharmacy Notice of Privacy Practices Acknowledgment
Pharmacy Notice of Privacy Practices Acknowledgment
(HS348B)
Women's Health Forms
Sexual Health Services Information Sheet
Confidential Women's Health History Form
Other Forms
Ed. C. Brown Scholarship Applications Available Here
Ed. C. Brown Scholarship Application
Health
Insurance Forms See
CMU
Student Health Insurance Plans
Note: To view the
(PDF) form, you must have the free
Adobe Acrobat Reader. Download it by clicking the Adobe logo below and following the instructions.
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Open Monday-Friday 8am - 5pm, Foust Hall
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