Kettering University

Health and Medical History Forms

Health and Medical History Forms

This Health and Medical History form must be returned on or before the first day of class. The information you provide is confidential for use by the Wellness Center. It will not be released to anyone without your knowledge or written consent. This form must be properly completed and signed before you may receive medical care at the Wellness Center.

Health and Medical History Form - This form can be completed and saved to your computer. The completed form can be emailed to Sue Cook, scook@kettering.edu.