Forms

If you can't find the form you're looking for below, please contact us at ImmunizationRecords@niu.edu or 815-753-9585.

Immunization Compliance and Records

Release of Information

A valid authorization signed by the patient is required to release any health information. Diagnosis of mental health, alcohol and substance abuse and AIDS/HIV are not included in a general authorization and must be indicated specifically on the release of information form. Please allow 24-48 hours process time for all releases. There is a cost to obtain personal copies. Please contact Health Services for more information 815-753-9578.

Release of confidential information form (PDF)

Student Insurance

Forms related to student insurance are available on the Aetna website.

Exception to Reimbursement Policy - Medical Documentation

Housing and Residential Services Change Request for Medical Reasons

Students requiring special needs changes concerning dietary issues, room accommodations, etc., for a specified semester.

Housing and residential services special request for medical reasons (PDF)

 

Contact Us

Student Health Center (To make an appointment)
1st floor Health Services Building
815-306-2777
815-306-2778 (FAX)
Monday-Friday
8 a.m.-4:30 p.m.

Immunization Compliance and Records

2nd floor Health Services Building
Phone: 815-753-9585
Fax: 815-753-9599

Release of Confidential Health Information

Student Health Insurance

2nd floor Health Services Building
Phone: 815-753-0122