As the director of BGSU’s Student Health Service, it is my goal to provide the best in health care services for you. Student Health Service provides students with high quality care for illness and injury as well as information about life choices that minimize illness and injury and promote physical and emotional wellness.

To get you off to a good start, we ask that you complete the following forms:

Health Assessment Form.
Immunization FormMedical/Prescription Insurance Information Form

• These forms require your immediate attention. They must be completed and returned to the Student Health Service as soon as possible.
• Be sure to fully complete all pages and have your health care provider sign both the physical examination and the immunization record.
• Please read the Privacy Notice and sign acknowledgement of its receipt on the Health assessment Form. This notice is required according to federal law and HIPAA.

In case you may be living in a residence hall, Ohio law requires either a record of meningitis and hepatitis B vaccination or a refusal of the vaccine. Please complete and sign the vaccination information in Parts E and F of the Immunization Record.

You are also required to have health insurance. Please complete all the requested insurance information and provide a copy of both sides of your insurance cards. If you do not have insurance or are underinsured, BGSU offers a reasonably priced student insurance plan. If you are covered by another comparable plan and do not need the BGSU plan, you need to complete and sign a waiver. Contact the Student Insurance Office to obtain a waiver.

Thank you in advance for your assistance in establishing a healthy environment for all students at BGSU. Please do not hesitate to contact your Student Health Service at 419-372-2271 for any questions you may have.

Sincerely,
Glenn Egelman, M.D., FACP
Director and Physician in Chief, Student Health Service