Forms

Flu Vaccine Clinic Forms

Watkins Health Service hosts flu vaccine clinics each fall. Please check back for information on Fall 2019 clinics.

Immunization History Form

The University’s Immunization History Form (PDF)* is required to be filled out by a physician or nurse and provided to Watkins Health Services. 

  • U.S. Students:  Seventy-two (72) hours after enrolling at orientation, you will be able to log into to the Watkins Health Services patient portal. Click on the "Medical Clearances" tab and select "Immunization Record" to upload your form. Alternatively, this form can be provided during any orientation session, mailed, faxed or hand-carried to:
    Watkins Health Services
    ATTN: Registration & Records 
    1200 Schwegler Drive
    Lawrence, KS 66045
    Fax: (785) 812-0214
  • International Students: Download and prepare this form before your arrival at KU. It must be completed in English and signed by your doctor. Bring it with you to your Health Check-In.

*In lieu of this form, Watkins Health Services can also accept an official copy of immunizations from a personal physician’s office, school, military, state record or childhood immunization booklet.

Health History Form

Students with allergies, complex medical conditions or chronic health issues should consider completing their Health History form online 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. 

  • U.S. Students:  Seventy-two (72) hours after enrolling at orientation, you will be able to log into to the Watkins Health Services patient portal. Click on the "Medical Clearances" tab and select "Health History Form" to get started.
  • International Students: Watkins staff will assist you in completing this form at your Health Check-In.

Authorization for Use/Disclosure of Information Form

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.

Pharmacy Prescription Transfer Form

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

Spouse/Domestic Partner Guarantor Form

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)

Insurance Form

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.

Summer Camp Medical Forms

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.

 


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Sat:  Closed
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