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
- 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.
- Health History Questionnaire (completed by Student) and Physical Form - Completed by Provider
Questions? Call 262-472-1300. We look forward to seeing you soon!
Disclaimer
All information on this website is written by UHCS professional staff unless otherwise noted. No data is collected on visitors to this site. Financial Support for this web site is provided by University Health & Counseling Service, Division of Student Affairs, University of Wisconsin-Whitewater. This web site does not accept advertising.
This site is not meant to replace the advice of a health care or counseling professional. You should not rely on any information on these pages, or information generated for you by this site, to replace consultations with qualified professionals regarding your own specific situation. Some links take you to a source outside of UHCS. The owners of that site, not UHCS, are responsible for the content.
