Get Umdnj/student Health Services

Completing the UMDNJ/Student Health Services form is essential for your health records and ensures that you receive the necessary care while enrolled. This guide provides a step-by-step approach to assist you in filling out the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by entering your name in the designated fields: last name, first name, and middle initial.
3. Mark your date of birth using the provided format: month, day, and year.
4. Indicate your gender by selecting the appropriate checkbox.
5. Provide your permanent address, including street, apartment number, city, state, and zip code.
6. Fill in your contact telephone number and email address for communication.
7. List your emergency contact details by entering their name, relationship to you, and their phone number.
8. Describe your usual health status by checking one of the options: excellent, good, fair, or poor.
9. Indicate your exercise habits by selecting from the options: never, sometimes, or often, and specify the type of exercise.
10. Report your tobacco usage by choosing one of the categories provided.
11. Specify your weekly alcohol consumption by selecting one of the options.
12. Indicate whether you have any ongoing health problems by selecting yes or no, and if yes, provide details.
13. If applicable, list any past surgeries, specifying procedure names and dates.
14. Indicate any hospitalizations not previously mentioned and provide reasons and dates.
15. Confirm if you have received treatment for any emotional or psychiatric issues; if yes, provide details.
16. List any allergies, including medication and reaction, or write none if applicable.
17. Detail any regularly taken medications, including prescriptions, supplements, and herbs.
18. State if your activity has been restricted in the past five years and specify the reasons if applicable.
19. For family medical history, assess various conditions and specify who in your family has had them.
20. Women should affirm whether they have had a regular gynecological exam and Pap smear.
21. Provide your signature and date certifying the accuracy of the information provided.
22. Complete the physical examination section, including submission by a non-relative healthcare provider.
23. Finally, review all entered information for accuracy, save your changes, and prepare to download, print, or share the completed document as needed.

Complete your UMDNJ/Student Health Services online form today to ensure your health needs are met during your studies.