Forms


If you are coming to the health center for the first time (for either clinic), please print the health assessment form and Medical Consent form and have them filled out by the time you come for your appointment.  If you are coming for a Women's Health appointment on Tuesday or Wednesday, please print and fill out the health history form for that particular clinic.

If you wish to obtain a copy of your immunization records or any part of your current medical file, please send an email to health@southeastern.edu.  In the email, state your name, student ID# and tell us what you are requesting.  We will attach it and email it back to you.

 

Available Forms:

1.  Health Assessment Form for ALL patients (general medicine clinic ONLY)

2.  Medical Consent Form for ALL new patients

3. Women's Health Clinic Health History for ALL Women's Health Clinic patients

4.  Proof of Immunization Compliance form

5.  SLU Athletics Physical Examination form

6.  Regina Coeli Child Development Center Physical Examination Form