Get Bellevue College Health Care Verification Form 2019-2025

The Bellevue College Health Care Verification Form is a crucial document for students seeking medical withdrawal, tuition refunds, or financial aid reinstatement due to health-related issues. This guide will provide you with clear, step-by-step instructions on how to fill out the form online, ensuring a smooth and efficient process.

Follow the steps to complete the Bellevue College Health Care Verification Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your name and student ID number in the designated fields. If the patient is not the student, include the patient’s name and their relationship to the student.
3. Provide the date of the first visit or the onset of the condition, followed by the last date of visit or resolution of the condition.
4. Describe the condition and explain how it has impacted the student’s ability to attend Bellevue College. If more space is required, you may attach additional sheets.
5. If you are the patient, sign the consent section of the form. If the health condition pertains to a family member, ensure they sign the consent section.
6. Take the completed form to the healthcare provider who treated the medical condition for further completion.
7. The healthcare provider will sign the consent form and confirm whether the condition has been resolved, allowing the student to return to school.
8. Have the healthcare provider complete the form and attach their office letterhead or business card.
9. Mail the completed form to Student Central – Appeals, B125, Bellevue College, 3000 Landerholm Circle SE, Bellevue, WA 98007.
10. Ensure to include the patient’s consent to release medical information, with the patient’s signature and date. If applicable, include the signature of a parent or legal guardian for patients under 18.
11. After filling out the form, users can save changes, download, print, or share the completed document as needed.

Ready to complete your Bellevue College Health Care Verification Form online? Follow these steps to get started.