Medical Forms for Registration

Here are some of the forms and information you need to complete and send to us before the fall semester begins.

Medical Forms

Prior to registration, new students must submit:

  • Confidential Medical History Report
  • Record of Immunizations
  • Emergency Instructions
  • Confidential Mental Health History Report
  • Notice of Privacy Practice Form

Download, print and complete the medical forms, then mail the completed forms to: 

Student Health
Nebraska Wesleyan University
5000 Saint Paul Avenue
Lincoln, NE 68504

Immunization records must be complete and returned prior to registration. This is a university requirement mandated by the State Department of Health and must by submitted to Student Health Services by all new, readmitted and transfer students. Proof of Immune titer or two properly administered immunizations for MMR (measles, mumps, rubella) must be indicated along with mandatory meningitis vaccination. Other immunizations are recommended.

Students who fail to provide the required immunization document during the first semester following admission to Nebraska Wesleyan University will be refused registration for the following semester unless a waiver form is signed.

Hepatitis A and B, Meningitis and Measles Information
NWU’s Student Health Services has compiled useful information regarding Hepatitis A and B, Meningitis and Measles.

Student Health Insurance Information
You can read more about health insurance here.