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

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

NEW Patients

2.  Medical Consent Form  for ALL new patients

ALL Women's Health Patients

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

ALL Incoming Freshmen & Transfer Students (for college entry)

4.  Proof of Immunization Compliance form

Other

5.  SLU Athletics Physical Examination form

6.  Regina Coeli Child Development Center Physical Examination Form

7. SLU General Physical Examination Form

8. Kinesiology Physical Examination Form