Forms

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Administration

• Official Semester Withdrawal Form   Application form for semester withdrawal from the University due to medical reasons
• Medical Request for Course Drop Request form for dropping and ECU course due to medical reasons
• Release for for Medical Withdrawal  Release authorization for Student Health Contact of patient's instructors

Insurance

• www.studentinsurance.com/PearceSite/Schools/NC/ECU/ECU Student Insurance application form

Medical Report

• Immunization/Medical Report Form  Medical Report Form for meeting NC Medical and Immunization Requirements for University admittance.

Medical Releases

• Charges for Medical Record Copies:   Form used when requesting copies of of medical records for personal use.
• Medical Release Individual:  Form authorizing Student Health to release medical information to that requesting individual.
• Medical Release Public:  Form authorizing Student Health do disclose a requesting individuals's confidential medical information to another medical office, insurance agency, law firm, etc . . .  

Physical Exam

• Physical Exam Form    Physical Examination Form required for Student Health Service conducted physical examinations