formerly University of Missouri-Rolla
Please update your bookmarks! All umr.edu web and email addresses disappear after July 31, 2008 [more]
Forms

 

If you can't find, messed up, threw yours away or whatever, we still require every patient to fill out the Medical History page 1 and 2. You may mail it to us at the address at the bottom of the page or fax it or hand deliver. Get it to us however works for you, but we must have it prior to giving any medical care to any student. Note that there are 2 sides to the form, and you or your legal guardian signature is required.

A completed Release of information is required to get information to us from another provider or for us to release information. Yes, that includes immunization records.

And here's the other "biggie"- Meningitis Compliance form.

Do you need to read again that under no circumstances should you send, nor will we accept, confidential medical information by e-mail? These forms are provided as a convenience to you, please print them and mail, fax or hand deliver them. The address/phone/fax is across the bottom of every page on this web site.

One last item, if you would please take the time...web site feedback.