Forms

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 New Student Orientation session, or 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.

When a student has seen one of our providers and as a result missed class or work, we can provide a document that some people call a Class Note or it may be referred to as an “Appointment Confirmation Letter.” This document is for use by the student to provide to his/her professor or work supervisor to show why s/he has missed or will miss class or work.

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.

Knowing what your health insurance plan covers here at Watkins will help ensure that you have no surprises if you have charges for services received here. We have created this Guide to help prepare you for calling your health insurance carrier.

Students who are enrolled exclusively at KU Medical Center (KUMC) or on Edwards Campus with no classes on the Lawrence Campus may still find it preferable to receive their healthcare here at Watkins Health Services, e.g. if they live in Lawrence. If a student prefers this, there are two options available to establish his/her eligibility to be seen at Watkins. Please refer to this form for an explanation of the options.  If you complete the form, you may fax it to the Business Office at 785-812-0213, or scan it and attach to an email to: whsbo@ku.edu.  If you have any questions, please contact the Business Office at 785-864-9520.

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 required urgent 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.