Western Illinois University: Macomb Campus

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WIU.edu

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Health Center Forms

• Health History Form
• Immunization Record Form
• Religious Waiver Form
• Authorization to Release Medical Information

Student Health Insurance

• Benefits at a Glance
• Claim Form
• Insurance Waiver
• Insurance Restatement Form

Vaccine Information Sheets

• Hepatitis B Vaccine
• Meningococcal Vaccine

Alternative Formats

Most of these forms are provided online in PDF format and require Adobe Reader. If you require any of these forms in an alternative format, please contact Beu Health Center at (309) 298-1888.

Contact Info

Beu Health Center
1 University Circle
Macomb, IL 61455

Phone: (309) 298-1888
Fax: (309) 298-2188
Email: beuhealthcenter@wiu.edu