Below you will find a number of forms which you may print out, fill in (forms marked with * can be filled out online), and bring into the UHC to expediate your next visit. All documents are in the .pdf format and require a .pdf reader such as Adobe Acrobat to view. For a free download of Adobe Acrobat visit the Adobe Website.
Consents & Insurance Information
BRING TO YOUR FIRST UHC VISIT OF EACH ACADEMIC YEAR
Consent for All Patients
PARENT/GUARDIAN MUST SIGN FOR AUTHORIZATION OF CARE FOR STUDENTS UNDER AGE 19
Clinical History Forms
Student Absence Form
The University Health Center cannot provide a verification of a student's illness or injury if we have not examined the student while they are sick or injured.
At the same time many illnesses do not require care by a health care provider.
If you are ill and miss classes, please contact your instructors immediately and refer to the "Explanatory Statement for Student Absence from Class or Work" located here. (NOTE: This is an editable form that you can print.)
Your instructors may have you fill out the form and return it to them.
BRING TO YOUR APPOINTMENT
Insurance Information Form
If you have Blue Cross Blue Shield insurance
Also bring your previous immunization records
For study abroad program physicals, bring the printed requirements list that you can find on My World
Permission for Use or Disclosure of Your Health Information
Camper Registration and Authorization Form If you are attending a summer camp at UNL