Outreach Flu Form

Immunization Record

Wayne State University (WSU) requires that your immunization records be on file at the Campus Health Center (CHC) before you move into your residence hall room.

Female History

Complete the Female History Form if you are coming in for a women’s health issue, contraception, or vaginal concerns.

Medical History

Complete the Medical History Form the first time you have a face-to-face visit with the provider at CHC.

Physical Clearance Exam

Complete the Physical Clearance Exam Form if you need a physical exam for your major/department of study. (ex. Nursing, Medicine, Education, etc.)

Sports Pre participation Physical

Complete the Sports Pre-participation Physical Form when you need a physical exam saying you are medically cleared to participate in sports or tryouts.

Vaccine Consent

Complete the Vaccine Consent Form each time you get a vaccine.

Medical Records Release

Complete the Medical Records Release form when you need CHC to release your medical records to someone outside of the clinic, or if you need CHC to request records from someone else. There are two forms; Ask us for questions/clarification.

TB Risk Assessment Outreach Form

TB Assessment English

Complete the TB Assessment Form in your language of choice if you are an international student coming to CHC for your TB clearance appointment for the first time, or if you’ve been back to your home country for 30 days or more.

TB Assessment Chinese

Complete the TB Assessment Form in your language of choice if you are an international student coming to CHC for your TB clearance appointment for the first time, or if you’ve been back to your home country for 30 days or more.

TB Assessment Arabic

Complete the TB Assessment Form in your language of choice if you are an international student coming to CHC for your TB clearance appointment for the first time, or if you’ve been back to your home country for 30 days or more.

TB Assessment Portuguese

Complete the TB Assessment Form in your language of choice if you are an international student coming to CHC for your TB clearance appointment for the first time, or if you’ve been back to your home country for 30 days or more.

Enrollment

Complete the Enrollment Form at your first visit to CHC, and annually moving forward.

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