A complete and accurate medical record (using the forms below) is required for entrance to St. Bonaventure Health Services. The Physical Examination and Immunizations
form must be filled out and signed by a health care provider. (Please note that to comply with New York State Public Health Law 2165, documented proof of immunity to measles, mumps and rubella must be submitted.) The Medical Record: Notification and Insurance
form is filled out by the student and parent/guardian.
Students who do not have completed health forms in Health Services
can receive emergency care only.
New York state has mandated that entering students from New York must complete the MMR and Meningitis forms within 30 days of starting classes, and students from outside of New York state or the U.S. must complete these within 45 days of starting classes.
Health Services is in the process of updating the following forms:
Effective Fall Semester 2010, we are providing health insurance and optional personal property insurance via Maskin. These letters and brochure provide information for graduate and undergraduate students about the health insurance.
Student Accident and Sickness Insurance Plan
Accident or Sickness Claim Form
Letter to graduate students
Letter to undergraduates
Please note: Verification of all current medical insurance coverage is mandatory. Forms will be available soon.
Release of Medical Information Form
As soon as a medical or contact change occurs, and at least annually, please notify Health Services. Knowing who to call and the correct phone number will reduce frustration when a referral is required by your insurance company. Newly diagnosed medical conditions and new or changed medication are important additions to your medical record; please have your health care provider sign this information. Please update any changes in name, address and phone number.
In order to send medical information, a release of medical information is usually required.
Release of Medical Information Form (form available soon).