Health History Update (Returning Students)

Please complete the following health history update. If you were married this past year, please include your spouse’s name along with your maiden name if applicable.
PERSONAL INFORMATION
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INSURANCE INFORMATION

Health Insurance is required of all students taking 6 or more credit hours. Students (taking 6 or more credit hours) will be enrolled in the FBBC&TS Student Health Plan and will be charged for the school year premium. If you have an existing health plan, that will provide adequate coverage while attending FBBC&TS, you may waive the school health insurance by submitting a copy of the front and back of your health insurance card.

I will be insured through the Student Health Plan offered by FBBC&TS. *


EMERGENCY NOTIFICATION
IMMUNIZATIONS
HEALTH CONCERNS
I certify that the above information is current and complete. I understand that in the event of illness or injury I am authorizing Health Services or a designated individual to give or obtain treatment. I will be financially responsible for any costs incurred. *
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