Forms
New/Incoming Student Forms
- Waiver Form
- Notice of Privacy Practices (NOPP)
- Quick Guide to Yale University Health Services
- Prescription Plus Amendment
- YHP Student Handbook
- Acknowledgement of Receipt of NOPP
- Instructions for Completing Pre-Entrance Health Forms
- Pre-entrance Health Form for Incoming Students
- Vaccination Record for Incoming Students
- Health Professions Vaccination Record (School of Medicine and School of Nursing)
- Authorization for Medical Care and Treatment
- Student Allergy Medical Treatment Plan
- Intercollegiate Athlete Medical Form
- New Student Health Checklist
- New Student Health Checklist (School of Nursing, School of Medicine & PA Program)
- Student Premiums/Rates
Benefit Enrollment Forms
- 19-25 Year Old Dependent Form
- Address Change Form
- Benefits Revision Form
- COBRA 18 Month Form
- Employee Enrollment/Change Form - Clerical & Technical, Service & Maintenance
- Employee Enrollment/Change Form - Faculty, Managerial & Professional
Health Information Services Forms
- Health Information Release Form
- Health Information Request Form
- Mental Health & Counseling Records Release Form
OB/GYN Forms
- Genetic Screening Form
- Instructions for 1 hour Glucose tolerance test
- Instructions for 3 hour Glucose tolerance test
- Ultrasound Instructions
Pediatric Forms
Student Forms
- Revoke Waiver
- Student Enrollment/Change Application (for dependents and Affiliate plan)
