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:

 

ALL Patients

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

 

NEW Patients

Medical Consent Form  for ALL new patients

 

ALL Women's Health Patients

Women's Health Clinic  for ALL Women's Health Clinic patients

 

ALL Incoming Freshmen & Transfer Students (for college entry)

Proof of Immunization Compliance form

 

Physical Forms

SLU Athletics Physical Examination form

Regina Coeli Child Development Center Physical Examination Form

General Physical Examination Form

Kinesiology Physical Examination Form