HEALTH CENTER FORMS

To download forms, please click on the links below.

Forms for Incoming Students:

Medical/Health Forms Packet  - Due by January 15, 2012 for transfer students

To learn more about university-sponsored insurance, go to www.gallagherkoster.com/wesleyan  .  Click here for insurance FAQs.

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

Oral Contraceptive (Birth Control Pill) Info

Travel Consultation Form

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

Edited on January 11, 2012