Forms


If you are coming to the health center for the first time (for either clinic), please print the health history form, Medical Consent form and Release of Information form and have them filled out by the time you come for your appointment.  If you are coming for a Women's or Men's Health appointment on Wednesday, please print and fill out the health history form for that particular clinic.

If you wish to obtain a copy of your immunization records or any part of your current medical file, please send an email to health@southeastern.edu.  In the email, state your name, student ID# and tell us what you are requesting.  We will attach it and email it back to you.

 

Available Forms:

1.    Health History Form for new patients (general medicine clinic ONLY)

2.   Medical Consent Form for ALL new patients

3.   Release of Information Form for ALL new patients

4.   Men's Health Clinic Health History for ALL Men's Health Clinic patients

5.    Women's Health Clinic Health History for ALL Women's Health Clinic patients

6.    Proof of Immunization Compliance form for ALL incoming students

7.    SLU Athletics Physical Examination form