Student Health Forms
Find forms for immunization records, release of information and a TB questionnaire within the list of available options from Student Health Services.
The following is a consolidated list of Student Health Service forms as PDF files:
- Immunization Record School of Medicine, MD Students
- Immunization Record - BSN, Advanced Practice MSN (except Psychiatric APRN), Advanced Practice DNP, RT, OT, PT, DPT, MSAT, CRNA, Speech & Language, Audiology, Diagnostic Ultrasound Technology, Dietetics & Nutrition Intern, CLS
- Immunization Record - Graduate Studies, HIM, HPM, SON PhD, Leadership MSN, Leadership DNP, Biostatistics (MS, PhD), Population Health, Dietetics & Nutrition MS and PhD, Advanced Practice Psychiatric Nursing, Molecular Biotech
- Release of information to the University of Kansas Medical Center
- Release of information from the University of Kansas Medical Center
- TB Questionnaire Form
The completed and signed forms along with immunization documentation and lab reports may be submitted by:
- mail to KUMC Student Health, 1012 Student Center, MS 4044, 3901 Rainbow Blvd., Kansas City, KS 66160.
- email your information to firstname.lastname@example.org or
- fax your information to 913-588-1943