Forms
Health History
Your health history must be completed at your first visit with UMKC Roo Wellness - Health Services, updated once per year, and sooner if there have been any changes. The purpose of this, is to provide information on your medical history, current medications, allergies and family history, all of which is extremely important for both you and your health care providers to know. Completing and updating your health history can be done on our portal. We will only use the below paper version in the event that our system is down.
Consent-Authorization for Release of Information
This form gives UMKC Student Health and Wellness permission to send, receive, or share your personal medical history. We will never share any of your medical records until we have received your permission.
Consent to Treatment of Minors
If you are under the age of 18, we are not able to treat you until we have this form completed by a parent or legal guardian.
Consent for Treatment
This form states that you are permitting us to provide you care; it must be signed by you. Typically, you will sign this form electronically at the kiosk when you arrive for your visit; however, this form may be printed and used if our computer system is down.
HPV Vaccine Assistance
This form is the application to apply for assistance on receiving the GARDASIL-9 vaccine.