Esry Student Health Center

	Health Center Home Staff & Hours Services Cost/Insurance Immunization Policy Immunization & Disease Information Medical Emergencies Frequently Asked Questions Before Arrival Checklist Forms Notice of Privacy Practices Blum Union , Room 203 (816) 271-4495 Mon.-Fri. 8am-4:30pm

Health Center

FORMS

Authorization for Disclosure (pdf)

Immunization Policy and Instructions (pdf)

Health History Form (pdf)

Tuberculosis Risk Assessment (pdf)

Immunization Documentation (pdf)

Waiver Request (Medical and Religious) (pdf)

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PH: 816-271-4200 | An equal opportunity/affirmative action institution.