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.
Gynecology
Please read to see what option fits you best and then print the appropriate forms.
- Initial Visit Form, Medical Information Form, and Claim Form - all women coming in for their first visit and are covered under the Kean University sponsored health insurance, United HealthCare, Inc.
- Initial Visit Form and Medical Information Form - all women coming in for their first visit and are using their own health insurance plan.
- Revisit Form & Claim Form - all women who have previously been seen at Health Services and are covered under the Kean University sponsored health insurance, United HealthCare, Inc.
- Revisit Form - all women who have previously been seen at Health Services and are using their own health insurance plan.
Men’s Clinic
- Initial Visit Form, Medical Information Form, and Claim Form- all men coming in for their first visit and are covered under the Kean University sponsored health insurance, United HealthCare, Inc.
- Initial Visit Form and Medical Information Form - all men coming in for their first visit and are using their own health insurance plan.
- Revisit Form with Claim Form - all men who have previously been seen at Health Services and are covered under the Kean University sponsored health insurance, United HealthCare, Inc.
- Revisit Form - all men who have previously been seen at Health Services and are using their own health insurance plan.
Medical Records
Medical Leave of Absences
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, EEO, and Residence Life and Housing offices, if applicable.
Absences 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
MEDICAL PARKING IS FOR SHORT-TERM NEEDS
The student, faculty, or staff member must submit the following in order to obtain a Medical Parking Permit:
- A doctor or medical care provider’s verification of diagnosis and length of disability
- The Medical Parking Permit form completed
- The form can be mailed or faxed to Health Services
The form must then be approved by Health Services.
Once approved, the form is faxed to the Parking Office, located on the second floor of the Administration Building. Parking decals are given only through the Parking Office.
Immunizations
Immunization Information Forms - all students wishing to discuss Immunization records related issues should have the following form filled out prior to your appointment.