Forms for New-Incoming Students

Health Services

University Health Services provides comprehensive primary care of illness and injury and is open for appointments with physicians and advanced practitioners six days a week. For descriptions of services and office information visit the Health Services site.

What You Need to Know:

Forms for new and transfer students entering Fall 2020:

Students will receive their Wesleyan Login Credentials on or around June 11, 2020, at which point you will be able to upload and complete documents on our electronic medical record system at wesleyan.medicatconnect.com. Please wait until that time to attempt the upload of forms and make certain you click "submit" frequently to save your data in the health portal.  You have about 60 minutes with each log in before the system will sign you out so clicking "submit" will assure your data is saved.

Health History Form

  • Wesleyan University Health History Form (filled out via the Student Health Services' Web Portal, (wesleyan.medicatconnect.com). The due date for completion of this form is July 1, 2020.

Immunizations
(Please note:  If you have documentation of MMR, you do not need to enter the same info under individual mumps, measles, rubella section in the portal.  Only put the MMR dates.

  • Obtain a copy of your official immunization record from your provider’s office, which is acceptable for immunization documentation. If that is not available to you, this downloadable immunization form can be accepted in lieu of your official immunization record, but must be completed and signed by your Health Care Provider. The State of Connecticut requirements and the University’s immunization policy can be found here.

Immunization Exemptions

Tuberculosis (TB) Screening

  • Wesleyan University, following recommendations from the Connecticut Department of Public Health, requires Tuberculosis screening for all new students, both domestic and international.

  • All new students must complete the Tuberculosis Screening Questionnaire found on the Student Health Services' Web Portal, wesleyan.medicatconnect.com after June 11. The TB Screening Questionnaire should be previewed here, to allow time to schedule TB Testing if required. Students with a positive TB screen will need to download/print the Tuberculosis Testing Form and review the form with a Health Care Provider for evaluation and TB testing. For more information regarding tuberculosis screening, click here.

Consent for Treatment Form

  • If over 18 years of age, please complete electronically on the Student Health Services’ Web Portal, wesleyan.medicatconnect.com.
  • If under 18 years of age, please download/print form here for both student and parent/guardian to complete.

Completed Forms/Records – Due July 1, 2020

  • Once completed immunization records, TB Testing Form (if required), Medical/Religious Waiver (if required), and Consent to Treatment Form (if under 18) can be scanned and uploaded to the Student Health Services' Web Portal, wesleyan.medicatconnect.com under "Document Upload”. 

Health Insurance

  • Please be sure to review the University Health Insurance Plan and if you have comparable private insurance to waive out at www.gallagherstudent.com/wesleyan. All students will be charged for University insurance on the July 13 billing; charges will be reversed for those with waivers for a comparable private insurance. Please note: all new/transfer students must either waive out or enroll in the University sponsored plan by August 12, 2020.

More Information:

  • International students will be scheduled to see a medical provider as part of International Student Orientation to review immunization records.
  • Parents are welcome to visit the Davison Health Center or contact us by phone, but students over 18 years of age are entitled to full medical information privacy protection. The Health Center can discuss details of evaluation or treatment only with the student’s signed consent.

If unable to complete the above requirements, please contact the health center for assistance. We can be reached at healthforms@wesleyan.edu or 860-685-2470.

 

******************************************************************************************

 

reader

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