Downloadable Forms

Health Forms

Complete these forms and bring them with you to your first visit at University Health Services.  With your health history and immunization records on file, we will have up-to-date information to aid in your care.

If you don't yet have a scheduled appointment, feel free to complete these forms and mail them to us at:

Medical Records
University Health Services
Foust Hall 200
Mt. Pleasant, MI  48859

Pre-entrance Health History Report

Pre-matriculation Immunization Recommendations

Notice of Privacy Practices


Pharmacy Forms

Pharmacy Patient Registration Form

Pharmacy Delivery Authorization Form

Pharmacy Notice of Privacy Practices Acknowledgment

Travel Health Forms

  • HS289-290THRegPtForms.docTravel Health Patient Registration Forms
Health Insurance Forms/Medical Records

Depo Provera


    We're open Monday through Friday, 8:00
    a.m.-5:00 p.m., in Foust Hall. For
    appointments, call (989) 774-5693.
 

CENTRAL MICHIGAN UNIVERSITY

1200 S. Franklin St • Mount Pleasant, Mich. 48859
Phone: 989-774-4000

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