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.
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KSU Medical Records Release Form (visits before April 1, 2014)
Use this form for medical records release requests for Student Health Services visits prior to April 1, 2014. The form can be hand delivered to any KSU WellStar Student Health Services location or faxed to 470-578-9332.
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Records Release from WellStar Student Health Services (visits after April 1, 2014)
Use this form for medical records release requests for Student Health Services visits after April 1, 2014. The form can be hand delivered to any KSU WellStar Student Health Services location or faxed to 470-578-9332.
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Records Release to WellStar Student Health Services
Use this form request that your primary care or other physician provides your records to WellStar Student Health Services.
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Immunizations Records Release Form
Use this form to request a copy of immunization records submitted to KSU as part of the enrollment process. Visit immunizations.kennesaw.edu for additional information on KSU’s immunization requirements.
Student Health Insurance Plan (SHIP) Forms
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Student Health Insurance Plan (SHIP) Enrollment and Information
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 $1984. 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.
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UHC Voluntary Enrollment Form
Use this form to 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.
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UHC Qualifying Life Event Form
Use this form if you have experienced a Qualifying Life Event (QLE) and wish to enroll in the SHIP plan for the remainder of the current coverage period. Examples of QLEs are a change in marital status, birth of a child, job loss or loss of coverage due to age.
Medical Resources
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CDC Travel Website
Please visit the CDC (Centers for Disease Control and Prevention) travel website to determine immunizations needed for travel outside of the country.
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Immunizations Information
As a unit of the University System of Georgia, Kennesaw State University is required to adhere to the Board of Regents Guidelines regarding immunizations for school entrance. For additional information on KSU’s immunization requirements, please visit immunizations.kennesaw.edu.
Schedule an Appointment
All clinic locations are closed through August 2020.
Our Services
Student Health Services provides comprehensive primary care on both the Kennesaw and Marietta campuses. Our clinical team is comprised of board certified physicians and advanced practice providers.
Our Locations
There are three locations to serve you: in Kennesaw, we are located at University Village and House 3215 on Campus Loop Road; in Marietta we are located in the Recreation and Wellness Center.
