Student Health Services

  • Tim Hodges, PsyD
  • Licensed Clinical Psychologist
  • Director of Health & Counseling Center
  • 785.594.8365
  • tim.hodges@bakerU.edu

Flu.gov
Centers for Disease Control & Prevention
Go Ask Alice

Health History Form

 

Tell us about yourself

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Father's/Guardian's Contact Information

 
 
 
 
 
 
 
 
 

Mother's/Guardian's Contact Information

 
 
 
 
 
 
 
 
 

Spouse's Contact Information

 
 
 
 
 
 
 
 
 

Tell us about your family's health history.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 









 
 

Insurance Information

 
 
 
 
 
 
 
 
 
 
You must submit a copy of your insurance card. Either scan and upload it, or photocopy it and mail it to Student Health Center, PO Box 65, Baldwin City, KS 66006.
 
 
 
 
 
 
Student-athletes must complete additional information including a physical examination by a medical doctor before participation is granted by the Athletics Department. Forms are available on the sports medicine page of the BU Athletics website: http://www.bakeru.edu/athletic-department/sports-medicine.
 
International students are required to purchase a health insurance policy through Baker University when they enroll in classes.
 










 
 


























 
 










 
 
 
 

Immunization Record

 
Immunity is required prior to registration. You must be in compliance with the immunization requirements to avoid a HOLD on your records at the Office of the University Registrar.
 
You must submit a copy of your immunization record. Either scan and upload it, or photocopy it and mail it to Student Health Center, PO Box 65, Baldwin City, KS 66006.
 
 

Required Immunizations

 
Meningitis (Menveo or Menactra) Mandatory
 
 

 
MMR (Measles, Mumps, Rubella)
 
 
 
According to Kansa State Dept. of Health & Environment, all students born after 1957 must have two doses of the measles, mumps and rubella vaccine.
 
Tetanus-Diptheria (Td or Tdap)
 
 
 
Polio
 
 
Tuberculosis
 
The state of Kansas requires each incoming university student (freshman and transfer) to complete the TB (tuberculosis) screening. Please complete the four questions below.
 
 
 
 
 
 
 
To review the at-risk countries go to www.stoptb.org/countries/tbdata.asp
 

Recommended Immunizations

 
Hepatitis B
 
 
 
 
Hepatitis A
 
 
 
HPV Vaccine (Gardasil)
 
 
 
 
Religious or philosophical exemption to immunization requirement:
 
 
Permission for medical treatment:
 
 
 

Clinic Location & Hours

519 Grove Street

The Health Center is located in the yellow brick house at the corner of Sixth and Grove.

Monday – Friday
Clinic: 9 a.m. – noon & 1 – 4 p.m.

The last walk-in appointment will be accepted at 3:45 p.m.

Closed daily for lunch.