Health Services - Forms

 


Completing these necessary forms will help to make your visit faster. All students must bring their Kean University ID and health insurance card with them to Health Services on the day of their appointment.

Please print, complete, and bring forms with you for your appointment:

 

Primary Care

  • Medical Information Form - all students who will be making their first visit to Health Services or any student who has had a significant change in their health status.
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Gynecology

Please read to see what option fits you best and then print the appropriate forms.

If you are…

Then you need to print…

coming in for a first visit.  

Medical Information Form

Initial Visit Form

Responsibility for Billing Form

someone who has been previously seen at Health Services.

Revisit Form

Responsibility for Billing Form

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STI Clinic

 

If you are…

Then you need to print…

coming in for a first visit.  

Medical Information Form

STI Clinic

Responsibility for Billing Form

someone who has been previously seen at Health Services.


STI Clinic

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    Medical Records


    Medical Leave of Absence

    If student will be absent for two (2) weeks or longer, a medical leave of absence is suggested.

    Student must be attending classes full-time or part-time during the fall or spring semesters only. No Medical Leaves are available during the summer.

    Student must complete and sign form.

    A medical authorization from his/her personal physician or medical care provider stating reason for leave must accompany form.

    Upon approval, copies are sent to the Registrar and also to Financial Aid, EOC, and Residence Life and Housing offices, if applicable.



    short-term Absence Due To Medical Reasons

    If a student will be absent from class for five (5) consecutive days or more due to medical reasons, the student must supply Health Services with the following information:

    • Documentation from a medical doctor or other medical care provider requesting authorization for “Absence due to Medical Reasons”.
    • Absence due to Medical Reasons form must be completed and returned to Health Services.

    If student will be absent for two (2) weeks or longer, a medical leave of absence is suggested.


    Medical Parking Permits

    Any student, staff, or faculty member needing a Medical Parking Permit should contact Disability Services http://www.kean.edu/KU/Disability-Services .

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    Immunizations

    Immunization Requirement Forms - All students must submit the appropriate immunization forms to comply with the state's regulations in order to register for future classes and receive grades.

     

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