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.
We typically do not track online programs, if you don't see your program listed on any of the immunization record forms listed below, please contact your program director.
The following is a consolidated list of Student Health Service forms as PDF files:
- Immunization Record - School of Medicine, BSN, SON – DP clinical programs (except psychiatric NP), DNAP, (D)CLS, BS RC, MS AT, Cert. Cardiovascular Sonography, Cert. Diag. Ultrasound/Vascular Tech, Cert. Nuclear Med. Tech.
- Immunization Record - DPT (On-campus & Hybrid), OTD, Entry-level, OTD, Post-professional, SLP, AUD, D&N - Internships, D&N – MS in D&N, D&M -PhD in Medical Nutrition.
- Immunization Record - MSN and DNP Leadership Programs, Psychiatric NP, SON PhD, SOM Graduate and Research Programs, SOM Biostatistics (On-campus), HIM, MS Genetic Counseling, PhD Therapeutic Science, PhD Rehab Science.
- 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 email@example.com or
- fax your information to 913-588-1943