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Forms
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.
Dental Offices in our area
