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Graduate, Certification, Professional Credit, Lifelong Learning, and Online Program Students

Students must complete one of the two options outlined below:

  1. Waiver Form - select this option to waive completion of the electronic forms.  If you subsequently utilize Clinical Services, this form becomes void and you will be required to complete the required electronic medical forms and pay the semester health center fee.
  2. If you plan to access healthcare through Clinical Services, you must complete the following forms:
    • Electronic Health History form
    • Electronic Insurance form (only if you are insured)
    • Electronic Notice of Privacy Practices form
    • Electronic Permission for Treatment Agreement (18 years or older) OR Consent for Treatment of a Minor (parent/guardian must download, print and submit)
    • Electronic Options for Meningitis Compliance (required for resident students) OR Options for Meningitis Compliance for a Minor (parent/guardian must download, print and submit)
    • Electronic Vaccine History form (no documentation is required for dates entered)
    • Email Lois Piehel to request that the semester health center fee be placed on your university account.
    • Click on the link to access the portal where the forms are located. You will need to enter your university network username (the beginning of your KU email address up to but not including the @ sign), password and date of birth. If you cannot locate or remember this information, contact the IT Help Desk at 610-683-1511.

Required Medical Forms