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Forms

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Health Information Receipt - For students requesting a copy of their entire health record. $10 fee and must accompany Health Information Release Form.

Health Information Release - For FORMER students requesting any portion of their health record. Current students can do this from MyJMUHealth.

Hepatitis and Meningitis Immunization Waiver - Needed for any student who would like to waive these vaccines.

Immunization Form - State required, must be signed by healthcare provider, dates entered into MyJMUHealth, and returned to UHC at address on form. Non-compliance will result in $50 fine and academic hold. Due:

  • Dec. 12, 2014 for spring 2015 semester start
  • July 1, 2015 for summer or fall 2015 semester start
  • Dec. 11, 2015 for spring 2016 semester start

Nutrition forms - Complete for initial visit with registered dietitian.

Religious Exemption Form - For students exempting immunizations due to religious reasons.

Safer Sex Supply Request Form - Request large numbers of condoms for programming in residence halls or classes.

Volunteer forms - For students interested in volunteering in the Health Center's medical clinics, front office, LGBT & Ally Education Program, or student organizations.