Health Administrative Services- Medical Forms
Welcome to Kutztown University!
We’re located on the first floor of Beck Hall and are here to help keep you safe & healthy! At the Health Center students can receive care from registered nurses, physicians, certified gynecological providers, mental health providers, and health education specialists without ever leaving campus!
In order to help us provide the best care possible, before you arrive to campus please log-in to your KU student health portal and complete forms related to your medical history.
To complete your forms:
- Using Chrome or Firefox, visit pnc.kutztown.edu
- Log-in using your MyKU user name, password, and date of birth (your user name is the first part of the KU email address. For example, for the email address TSmith123@live.kutztown.edu, the user name is TSmith123)
- Click on FORMS on the left side of the page
Forms to be completed include:
- Consent for Treatment
- Health History
- Health Insurance
- Notice of Privacy Practices (HIPAA)
- Options for Meningitis Compliance
- TB Screening Questionnaire (* If you answer yes on this form, print and take to your Health Care Provider.)
Each form must be completed and submitted individually.
Log-in problems? Call the KU IT Department at 610-683-1511
Questions about the forms? Call the Health Center at 610-683-4082, Option 2
If you are an NCAA student athlete, additional forms are required to be completed. For questions or information related to NCAA athletic requirements, please email firstname.lastname@example.org
We look forward to meeting you!
The KU Health Center Team
If you are uninsured, the Affordable Care Act (ACA) provides many options for health insurance coverage. Visit Healthcare.gov or call 1-800-318-2596 to see if you are eligible to enroll in a policy. Students may qualify for a subsidy to assist in payment of the premium. The window for enrollment is open in November, however, there are certain circumstances that permit enrollment anytime.
International Students - Undergrad
International Students - Grad
Graduate, Certification, Professional Credit, Lifelong Learning, and Online Program Students