Required Medical Forms

 

Before attending Sacred Heart University, each student must complete and submit necessary medical paperwork to ensure a healthy experience. In order to serve you in the most effective way and to comply with Connecticut State Law and Health Codes, the university requires you to complete the forms below.

Download, print and fill out ALL forms in the following order:

Completed forms should be sent to:

Sacred Heart University
Attn: Health Services
5151 Park Avenue
Fairfield, CT 06825
All forms must be received NO LATER than July 15, 2013
 
Insurance Information
As a full-time undergraduate student you are required to have health insurance while enrolled at Sacred Heart University. You have the option of purchasing the student insurance plan from our select provider(Gallagher/Koster) or waiving the student insurance if you are currently enrolled in an insurance plan of comparable coverage. All international students are required to participate in the student insurance plan and will be automatically enrolled in and billed for this insurance plan.

Proof of insurance coverage must be verified by submitting a copy of membership ID insurance card (or another form of proof) to Health Services.

Directions to Waive or Enroll in The Student Accident and Sickness Insurance Plan for 2013-2014:
  1. Log onto: www.gallagherkoster.com/SHU
  2. Click on Student Waive/Enroll
  3. Enter your SHU Student Email as your User ID and you SHU Student ID as your Password
    • To enroll, select the GREEN "I want to Enroll button
    • To waive, select the Red "I want to Waive" button.  When waiving, please have your health insurance ID card as you will need this info
    • If you don't submit a waiver form by the deadline date, you will be automatically enrolled in the insurance plan and be billed by SHU bursar with the insurance going into effect beginning on 9/1/13.

More Information

 

Counseling Center
Tel: 203-371-7955
Fax: 203-365-4743

Health Services
Tel: 203-371-7838
Fax: 203-365-4743
 
 
 
 
 

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