Forms

Print appropriate form, complete and bring with you to Student Health.


Registration Form for Student Health (PDF)
(*This form is to be completed  before seen as a patient)

Mask Fit (PDF) (Medical Questionnaire for N-95 Respirators Form)

Respiratory Questionnaire (PDF) (Medical Questionnaire for half or full facepiece)

Tuberculosis Evaluation (PDF) (Positive Tuberculosis/ Q-Gold Evaluation Form)

Student Accident & Injury Report Form (PDF)

Lab Clearance Form

2020-21 Flu Declination Form

 
Click here for Student Counseling Services Phone Number to call: (409) 747-HELP (4357) Depressed, Anxious, Suicidal?
Let Us Help

(409) 747-HELP (4357)

UTMB Student
Mental Health
Crisis Line
Professionals Available 24/7/365

Location Information:

Lee Hage Jamail Student Center
301 University Blvd - 3rd Floor
Galveston, TX 77555-1369

Phone: 409-747-9508
Fax: 409-747-9330
Email:  stdwappt@utmb.edu

Hours:
Monday-Friday 8am - 5pm
*Major credit cards only.

Campus Maps
campus

After Hours Care:

After hours, weekends, and holidays, you may call the Access Center at 409-772-2222 or 800-917-8906. Telephone triage is provided by the Hotline and physician backup consultation is available.

Emergencies:
Please go directly to the nearest emergency room. Students are responsible for all charges related to emergency care.