Kutztown University: Health & Wellness Center

P.O. Box 730, Kutztown, PA 19530
Phone: (610) 683-4082
Administration Fax: (610) 683-4635
Clinical Services Fax: (484) 646-4159
After-Hours Emergencies (610) 683-4001
(Public Safety & Police Services)
Clinical Services
Dolores Hess, Director
William Lendzinski, Asst. Director
Health Administrative Services
Gail Hirsch, Medical Records Manager

CLICK FOR TB TESTING INFORMATION

REQUIRED MEDICAL FORMS
WHO MUST COMPLETE THE REQUIREMENTS:
* ALL NEW UNDERGRADUATE STUDENTS
* Students that plan to use Clinical Services and/or live on campus and/or enroll in the university health insurance plan.

COMPLETE THE FOLLOWING TWO-STEP PROCESS:

U.S. CITIZENS:
1. IMMUNIZATION REQUIREMENT FORM - This form cannot be completed electronically. Print the form from the link or watch for a direct mailing with the information.
2. ON-LINE REQUIRED MEDICAL FORMS - Log onto MY HEALTH LINK to complete the forms.

            INTERNATIONAL STUDENTS:
1. IMMUNIZATION & INSURANCE FORMS
2. ON-LINE REQUIRED MEDICAL FORMS - Log onto MY HEALTH LINK to complete the forms.

Text Only Version is a standard of the Americans with Disabilities Act.
Send comments to: webmaster@kutztown.edu
©1994-2005 Kutztown University of Pennsylvania. All Rights Reserved.
The KU logo is a registered mark of Kutztown University of Pennsylvania.
Please read our privacy statement.

Kutztown University of Pennsylvania
P.O. Box 730, Kutztown, PA 19530
610-683-4000 • TDD: 610-683-1315, 610-683-4499
Member of Pennsylvania's State System of Higher Education