Get Emu Grad Student Health Information Form

Completing the EMU Grad Student Health Information Form online is an important step for all enrolled graduate students. This guide provides clear and supportive instructions to help you navigate each section of the form efficiently.

Follow the steps to fill out your health information form

1. Click the ‘Get Form’ button to obtain the EMU Grad Student Health Information Form and open it for editing.
2. Begin by filling in your personal details. Enter your full name, including last name, first name, and any additional names. Be sure to include your local mailing address, city, state, and zip code clearly.
3. Input your home and cell phone numbers, age, date of birth, and country of birth. Specify your sex by selecting either 'Male' or 'Female'.
4. Provide your Social Security number if required. Include the name of your emergency contact, their relationship to you, and their phone number.
5. Indicate your health care provider and provide their contact number. Answer whether you were previously enrolled at EMU and if so, include your name during prior enrollment and departure date.
6. Complete the health insurance information section. Upload a copy of the front and back of your insurance card or provide details about your insurance coverage.
7. Address the personal and family history by checking any relevant illnesses and noting relationships. Fill out any hospitalizations, surgeries, and current medications you may be taking.
8. Sign and date the form at the designated area to confirm that you understand your responsibilities regarding medical expenses and information sharing.
9. If immunization records are needed, request these from your healthcare provider and ensure that they complete the immunization record section accurately.
10. After completing the form, carefully review all the entered information for accuracy. Save your changes before proceeding to either download, print, or share the form as needed.

Take the next step by filling out your EMU Grad Student Health Information Form online today.