Forms

Watkins Health Service hosts flu vaccine clinics each fall. Save time by completing the necessary forms in advance.

The University’s Immunization History Form (PDF) is required to be filled out by a physician or nurse and provided to Watkins Health Services during any Orientation session, mailed, faxed or hand-carried to Watkins:

Students with allergies, complex medical conditions or chronic health issues should consider completing our Health History form prior to a visit at Watkins Health Services. This will enable our clinicians to have advanced notice of significant issues that may be impacting your health. There are two ways to complete this form:

• Online: Seventy-two (72) hours after you have received your KU online ID, you will be able to log into our patient portal which we call “myWHS.” You will find the large blue button for the login page in the right margin of most of our webpages. Once you have logged in, you will see a tab called “Forms” on the left side-bar.
• In Paper: This is where you will be able to open a paper form which you can print-off and complete by hand. If you are an international student, you must submit the form IN-PERSON. U.S. students may submit them by mail or fax:

The WHS Authorization for Use/Disclosure of Information (PDF) is used when patients want to request their past healthcare information be disclosed to entities outside of Watkins Health Services. This form is not acceptable for use by students to pre-authorize disclosure of any healthcare information that will be collected or created in the future. We do not allow students to sign these forms in advance of receiving care because they do not yet have a full understanding of what their information may contain, thus, this would not be a true "informed consent." If questions arise about the use of this form, please contact our Registration & Records Department at 785-864-9506 or 785-864-9494.

To transfer a prescription to Watkins Pharmacy, complete the Prescription Transfer Form(PDF) and bring it or fax it to our pharmacy.

Student spouses and/or domestic partners are eligible for the same services as currently enrolled students. The following form must be completed by the enrolled student.  For more information refer to our Eligibility for Services.

Spouse - Domestic Partner Guarantor Form (PDF)

We will submit claims to any insurance company although we are only in-network with certain carriers. We recommend that you have a copy of your insurance card with you at all times.  If you do not have a card for your insurance, we recommend this completed Insurance Information Form (PDF) be with you at all times.  Upon your first visit to Watkins, we will ask for this information.

We recommend for parents to complete this packet of medical forms (PDF) in advance of their child's summer youth camp. These would be given to the Camp Sponsor/Director for safe-keeping.  In the event that your camper requires medical care at WHS, the Camp will provide someone to bring him/her to our facility along with the packet of forms.  These will enable us to initiate prompt care of your camper.