Health Forms | Kean University World Class Education

Page Header

Health Forms

Page Sub Header

Health Services

Health Forms

Completing these necessary forms on the patient portal will help to make your visit faster. Please visit the Pyramed Patient Portal at to begin.

All students must bring their Kean University ID and their health insurance card, if necessary for the appointment, with them to Health Services on the day of their appointment.

Important: If you are under the age of 18 at the time of your appointment, please print this form and have your parent or legal guardian complete it before your appointment. You can email the completed form to, fax it to our office at 908-737-4888, or bring it with you to your appointment. Minor students can not be seen for medical evaluation without consent.

If forms are temporarily unavailable via the Pyramed Patient Portal, please print the following forms and have them filled out prior to your appointment.

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.
Medical Information Form
Billing Responsibilty

GYN Initial
GYN Annual

STD Clinic
STD Clinic

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.
Medical Leave of Absence Authorization

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 ìAbsence due to Medical Reasons.
Short-Term Absence Due To Health Reasons

Any student, needing a temporary Medical Parking Permit should contact Disability Services. 
All faculty and staff should contact Human Resources.

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.


Inner Page Footer