Forms

If you are under 18 years of age, you cannot be seen without a signed consent from your parent/guardian. Please have your parent/guardian complete both of the forms below and submit them to the Health Center via fax or email.

General Consent Form

Consent for Preferred Communications

 

Additional Forms

Accessing your medical records is more convenient than ever with two simple options:

If you are wanting access to your medical records, consider signing up for the MY IU Health patient portal account.  You should speak with someone in the front office who can send you an email invite from My IU Health which will contain a link to create an account.  They will advise you of a 4-digit activation code that you will need to enter as well.  You can view notes and lab testing results at your convenience online.

Sign in to My IU Health

To obtain your medical records, where you want to have them sent to another healthcare provider or if they are not viewable through the My IU Health patient portal, you will need to complete the Authorization to Release Health Information.

  • Contact the Health Center at 765-285-8431 or healthcenter@bsu.edu if you are not able to download the form to request a copy of the "Authorization to Release Health Information" form or come in person to make your request.
  • Copies of medical records are available through a company that is contracted to provide this service, sent where requested by the patient and is subject to a possible fee.
  • Picture identification is required.

Please send your completed Authorization to Release Health Information form to:

Ball State University Student Health Center
1500 W. Neely Ave.
Muncie, IN 47306
Fax: 765-285-1103

healthcenter@bsu.edu