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Office Information
Confidentiality HIPAA
Forms
Frequently Asked Questions
Location and Hours
Mission Statement
Patient Rights
Patient Satisfaction Survey
Staff
Insurance & Fees
Birth Control Fees
Health Insurance
No Show Fees
Service Eligibility and Fees
Price List
Miscellaneous
Medical Excuses
Medical Leave
Medical Records Request
Prescription Assistance
Referrals
What to Bring
 


 

   

HEALTH CENTER FORMS

 

To download forms, please click on the links below.

Forms for Incoming Students:

Medical/Health Forms Packet  - Due by July 15

To learn more about university-sponsored insurance, go to www.kosterweb.com 

If you need to contact the Health Center, please call 860-685-2470 or email jwalter@wesleyan.edu or mschukoske@wesleyan.edu

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*Please NOTE:  Incoming Students DO NOT need to return the forms below.  These forms are for visits to the Health Center.

*Miscellaneous Forms for Records/Visits:

Allergy/Immunotherapy Packet

Health Records Release Form

Wellness and Sexual Health Pre-visit Form

Gynecological Health Pre-visit Form

Travel Consultation Form

 

Documents are in .pdf format and require Adobe Reader to view.  Download Adobe Acrobat Reader.

 

 

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Edited on May 13, 2008