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Health Services


812-877-8367
studenthealth@rose-hulman.edu

  • Our Services
  • Patient’s Rights & Responsibilities
  • Frequently Asked Questions
  • Medical Excuse Policy
    • Notes for Faculty
  • Forms
  • Helpful Resources
  • Location & Contacts
  • In Case of Emergency

Forms

The Office of Health Services does require forms for various situations.
These forms are listed below and are available for download.

Freshman/Transfer Student Forms

  • New Student Letter
  • Policy for Medical Records
  • Required Documents Checklist
  • Physical Exam Form
  • TB Skin Test Law/Information
  • Immunization/Screening record
  • Medical Consent to Treat
  • Meningitis Information
  • Meningitis Acknowledgment Form
  • Patient Privacy consent
  • Immunization/Religious Contradiction
  • Disability Disclosure
  • Suggested Items to Bring

Exchange student forms

  • Exchange Student Letter
  • Policy for Medical Records
  • Required Documents Checklist
  • Physical Exam Form
  • TB Skin Test Law/Information
  • Immunization/Screening record
  • Medical Consent to Treat
  • Meningitis Information
  • Meningitis Acknowledgment Form
  • Patient Privacy consent
  • Immunization/Religious Contradiction
  • Disability Disclosure
  • Suggested Items to Bring

Graduate student forms

  • Graduate Student Letter
  • Policy for Medical Records
  • Required Documents Checklist
  • Physical Exam Form
  • TB Skin Test Law/Information
  • Immunization/Screening record
  • Medical Consent to Treat
  • Patient Privacy consent
  • Immunization/Religious Contradiction
  • Disability Disclosure

Incident - Accident Report

 


Rose-Hulman Institute of Technology
5500 Wabash Ave
Terre Haute, IN 47803
812-877-1511


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