Forms

Read the Frequently Asked Questions about Student Health Insurance.

• Student Health Form
  For newly matriculating students only. The due date for completion of this form is July 15, 2013. If your physical exam is not scheduled until after July 15, please complete and submit pages 29, 30 and 31, with a note indicating the date of your physical. Once your physical is complete, please submit page 32. Please be sure to review the Student Health Insurance Plan and, if you have comparable private insurance, to waive out at www.gallagherkoster.com/conncoll. You must also submit a copy of your private insurance card, front and back, to Student Health Services.

  Send to:
  Student Health Services
  Box HLTH CTR
  Connecticut College
  270 Mohegan Avenue
  New London, CT 06320-4196

• Health Records Request Form
• Medical Leave Return Letter
• AD/HD Exchange of Information Form (pdf)
• Religious Exemption Form
• Exchange of Information Form/Medications Refills
• Online Waiver of Student Health Insurance - Consult the Insurance info page
• Medical and RX Claim Form
• Club Sports Health Information Form
• Study Abroad Health Screening Form
• Student Accident Claim Form
• TRIPs Health Screening Form (pdf, short form)
• Pre-Travel Health Questionnaire (for use after acceptance to program)
• Temporary Medical Need Accommodation

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