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
• Counseling Services Release of Information
• 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.

Questions? Call 262-472-1300. We look forward to seeing you soon!