Forms and Links

Medical Records Release Documents

All requests for medical records, including legal inquiries, must be addressed to WellStar KSU Student Health Services as of April 1, 2014, and will be processed by CIOXX records services.

  • Complete this medical records release request for Student Health Services visits prior to April 1, 2014. The form can be hand delivered to any Student Health Services clinic or faxed to 470-578-9332.

  • Complete this Wellstar medical records release request for Student Health Services visits after April 1, 2014. The form can be hand delivered to any Student Health Services clinic or faxed to 470-578-9332.

  • Request that your primary care or other physician release your health records to Wellstar Student Health Services.

  • Request a copy of immunization records submitted to KSU as part of the enrollment process. 

Student Health Insurance Plan (SHIP) Forms

  • The University System of Georgia offers an affordable health insurance option for students enrolled at KSU. Please read our updates on enrollment for the Student Health Insurance Plan below:

    • The deadline to enroll in the Student Health Insurance Plan was Friday, September 7.
    • Students who paid the original annual premium for Spouse or Spouse + All Children coverage will receive a partial refund from United Healthcare on or after September 14.
    • Students who do not receive their refund by September 21 should contact United Healthcare at 866-403-8267.
    • Students enrolling in Spouse or Spouse + All Children coverage for a semester will receive a pro-rated reduction in the cost of coverage. The coverage cost for students enrolling in Spouse or Spouse + All Children is being reviewed by the University System of Georgia and is expected to be reduced by $1,984. The new rates, updated forms and an updated brochure will be published as soon as they become available.

    For a summary of the SHIP plan and eligibility requirements, please download the SHIP Brochure.

    Read more about United Healthcare's Student Insurance.

  • Enroll in the SHIP program in conjunction with a Qualifying Life Event (QLE). This form is required when enrolling in the current coverage period and open enrollment is closed. This form also has dates of coverage and the corresponding plan rates.

    Download Form

  • If you have experienced a Qualifying Life Event (QLE) such as a change in marital status, birth of a child, job loss or loss of coverage due to age, you can enroll in the SHIP plan for the remainder of the current coverage period.

    Download Form

Medical Resources

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