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Downloadable Forms

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Pre-Registration Forms:
Preregistration Health Requirements for Clinical Students (Dental, Medical, Nursing, Occupational Therapy, Physical Therapy)   

Preregistration Health Requirements for Non-Clinical Students (Public Health, Human Nutrition, Graduate School of Arts and Sciences, Post-Doctoral Fellows)

Medical Forms:

   CUMC SHS Medical Record Release Form
   CUMC SHS Medical Record Request Price List
   Travel Verification Form
   Influenza Vaccine Outside Documentation Form 2014-15
   MHS Consent Form
   Health Care Proxy

Pre-Registration and Medical forms should be sent to the Student Health Service via one of the following methods:
Preferred: Scan and email** completed forms to:

Fax: 212-305-2176
Mail: 630 West 168th Street, P&S Box 77, NYC 10032
In Person: 60 Haven Avenue, Floor Lobby

Enrollment Forms:

Dependent Enrollment Application
2014-2015 Post Doc Fellow Enrollment Application
Approved Leave of Absence Enrollment Application
Verification of Approved Leave Application
Petition for Spring Insurance- February Degree Candidates

Petition for SHS Waiver for CU Employees

Part-Time Enrollment Application


Other Forms:

Petition to Enroll or Drop/Life Change Event Form
2014-2015 SHS Waiver for >50 Miles
Dual Degree Students

Enrollment and Other Forms should be sent to the Student Health Service by email at or via one of the following methods:

Fax: 212-342-3947
In Person: 60 Haven Avenue #3E


CUMC Medical Plan Summary of Benefits 14-15
Columbia Student Dental Plan
Aetna Advantage Dental Plan Brochure
Getting What You Want from Alcohol and Other Substances

**Documents are sent to a secure email address. Ensure the address is entered correctly, so your health information does not go to the wrong address. You will receive a confirmation email receipt



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