Forms
Forms
University Health and Counseling Services requests all incoming students fill out 5 online health forms prior to using clinical services. To complete these forms, go to the MYUHCS Portal.
- Login to MYUHCS with your campus assigned User Name and Password.
- After login, select "FORMS" from the left column to complete the 5 health forms
Mailing address:
University Health & Counseling Services
800 W. Main Street
Whitewater, WI 53190
UHCS Medical Records FAX: 262-472-5608
UHCS Counseling Records FAX: 262-472-1435
Forms:
- Health Services Release of Information Printable PDF
- Health Services Release of Information Fillable PDF
- Counseling Services Release of Information Printable PDF
- Counseling Services Release of Information Fillable PDF
- Allergy Injection Agreement
- No Show Appeal Form
- Acknowledgement of Trainee Status
- Athlete Sports Physical Forms (as required by UW-W Athletic Dept)
- Health History Questionnaire (completed by Student) and Physical Form - Completed by Provider
Student-Athletes--Please complete the History Form (pages 1 and 2) prior to your visit. Bring all 3 pages to your appointment for review and completion of the Physical Examination Form.
- Health History Questionnaire (completed by Student) and Physical Form - Completed by Provider
Questions? Call 262-472-1300. We look forward to seeing you soon!