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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
   Meningococcal Meningitis Response Form
   Influenza Vaccine Outside Documentation Form 2013-14
   MHS Consent Form

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 Form
   2013-2014 Post-Doctorate Fellow Enrollement Application
   Part-time and Approved Leave Enrollment Application
   Verification of Approved Leave Application

Other Forms:
   Petition for Waiver of Spring Health Fee(s) – February Degree Candidates
   Petition to Enroll or Drop After Deadline/Life Change Event Form
   2013-2014 SHS Waiver for >50 Miles
   Dual Degree Students

Enrollment and Other Forms should be sent to Kimberly Gonzalez via one of the following methods:

Fax: 212-342-3947
Mail: 630 West 168th Street, P&S Box 77, NYC 10032
In Person: 60 Haven Avenue #3E


2013-2014 Aetna Student Health Insurance Plan Brochure
2013-2014 Student Health Service & Student Health Insurance Brief Guide
2013-2014 Aetna Student Health Insurance Highlight Sheet
2013-2014 SHS Overview Brochure

2013-2014 Mental Health Services Brochure

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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