Medical Forms
All students registered for one credit hour or more are eligible to use the services provided by UHS, regardless of whether they enroll in the University Medical Plan or have other insurance coverage.
All students, including the Lerner School of Medicine, Cleveland Institute of Art, Cleveland Institute of Music, Ohio College of Podiatric Medicine, and the Masters Program in Anesthesia, are required to submit a Personal Information Form and Immunization Record whether or not they plan on using University Health Service for their medical needs.
Once accepted to the university, students will receive an envelope by mail with instructions on how to obtain the forms and return them to University Health Service. Those who have not received an envelope by mail can contact the admissions department of the school they will be attending. The New Student Medical Packet is also available online. You can print the forms, complete them, then mail them to University Health Service.
Students enrolled in the school dentistry may be asked to send a copy of their immunizations to the school they attend. Please note: Students still will be required to send the information to University Health Service.
If you are enrolling for the fall semester, we ask that you complete and return the forms by July 1. For the spring semester, forms should be returned by January 1.
If you are having difficulty completing the Immunization Record, we will accept a copy of your high school immunization record attached to the form. Please submit any available information you have. Once we review it, we will let you know if we need additional information.
If you have questions about the forms, please contact the following staff:
Online Forms
You may fax the form to us at 216.368.8530, but we cannot mail the information to you until we receive the original request by mail. We require a minimum of four working days after we receive the form to process it. Please note: we cannot fax medical information, due to patient confidentiality laws. If you have questions, please contact Vicki Holzhauer at 216.368.4539 or e-mail healthservice@case.edu.