Student Health Links

Administration (fax 252 328-4397)

• 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 an ECU course due to medical reasons
• Release for for Medical Withdrawal  Release authorization for Student Health Contact of patient's instructors

Insurance (fax 252 328-0462)

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

Medical Report (fax 252 328-4007)

• Immunization/Medical Report Form  Medical Report Form for meeting NC Medical and Immunization Requirements for University admittance.  Clicking this link will redirect you to our secure website, Online Student Health.  Login with your PirateID and password.  Next click the Medical History link to complete the form.

Parental Consent for Treatment (fax 252 328-0462) 

• Parents Consent for Treatment of Students Under Age 18  Consent form to be completed by parents of students under age 18.  The form should be completed and given to the student prior to their first visit to SHS.

Medical Releases (fax 252 328-0462)

• Charges for Medical Record Copies:   Form used when requesting copies 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 to disclose a requesting individuals 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