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Health Forms

New Wisconsin Lutheran College students are required to provide their health history, immunization record, and personal health insurance information. They must also provide the results of a recent physical exam if they are or plan to be a student-athlete, or if they have a chronic medical condition. The forms below are for 2020-2021 only. New forms for 2021-2022 will be made available by July 1, 2021.


    All new traditional undergraduate students who are not planning to compete in Warriors Athletics are required to complete the WLC Health Form and provide the necessary documentation as indicated. This information will be submitted via Patient Fusion, which links to our HIPAA-compliant Electronic Health Record at WLC Health Services. Failure to complete the required form and/or provide documentation may result in restrictions from campus activities and/or residency. The WLC Health form and necessary documentation must be completed by August 1, 2020.

    To streamline this process, all of the required health-related information is separated into three sections and condensed into one form. Be prepared to complete information pertaining to your:

    Personal Health History

    This information will be used if you seek support at WLC Health Services and in case of emergency. The health history you submit informs our medical staff to help develop a baseline of care. As noted on the form, if you have a chronic medical condition you must also provide a copy of a recent physical exam. You may take a copy of WLC's Physical Exam Form to your doctor or submit the doctor's own form.

    Personal Health Insurance

    WLC Health Services requires personal health insurance information and supporting documentation in the form of a copy/photo of the front and back of your insurance card(s) and prescription benefit card, if applicable. This information will be used in case of an emergency and/or when services are being ordered that are outside the scope of practice on campus.

    Immunization Information

    WLC requires documentation of your current immunization record. If you do not have your immunization record, contact your health care provider or search your state's immunization registry. You will need to upload the document/picture of your immunization record or complete the WLC Immunization Form. The following immunizations are required:

    • Measles, Mumps, and Rubella
    • Diphtheria, Tetanus, and Pertussis
    • Tetanus should be less than 10 years old
    • Varicella vaccination or date of Chicken Pox disease.
    • A negative TB skin test is required if you have lived abroad prior to arriving on campus.

    You also must review the Vaccine Information Statements for Hepatitis B and Meningococcal ACWY.

    If you have not been immunized, select that option from the drop down menu in the WLC Health Form. You will receive communication from Health Services regarding the need to complete an immunization waiver.

    Patient Fusion Account Instructions

    All health-related information and documentation will be submitted via Patient Fusion. To assist in the completion of the WLC Health Form, the following PDF tutorials are available to help you complete this process:

    1. You will first need to create a Patient Fusion account. Please note that the email you receive is automatically generated from our Electronic Health Record. You will need to complete the following steps to submit your WLC Health Form and provide supporting documentation. After you complete these steps, then you will be able to access your WLC Health Records.

    Create Your Patient Fusion Account

    2. After creating your Patient Fusion account, you will have access to the WLC Health Form. Follow the steps outlined in the tutorial to complete the necessary information and submit the required form. Be sure to note any documentation required for your specific health history.

    Complete Your Required Health Form

    3. Patient Fusion Messages provides an easy way for you to send supporting documents or to ask questions at any time. To complete the WLC Health Form, the student must send two messages (at minimum) with the appropriate documentation:

    • A copy/picture of the front & back of their personal health insurance card(s) and prescription benefit card, if applicable.
    • A copy/picture of your immunization record or the fillable form.

    Pending your medical needs, you may also need to provide a copy of a recent physical exam and/or your current medical treatment plans (Questions 6 and 8). If you require accommodations (Question 15), additional documentation will also be required.

    Sending Messages and Attaching Documentation

    Contact Health Services at 414.443.8630 or if you have questions or concerns.


    Returning students should bring their personal health insurance card to campus (a copy or electronic version is acceptable).

    When a requesting an appointment with Health Services, you will be given directions on how to upload your insurance card and complete the necessary appointment intake form(s).

    2020-2021 STUDENT-ATHLETES

    If you will be or plan to be a student-athlete at WLC, you ONLY need to access the HIPAA-compliant online Athletic Trainer System (ATS) Portal to submit your health history and other required information. The Student Health Center will import your information from the ATS Portal for their files.

    Please let the Warriors Athletic Training staff know if you have any questions or concerns. You can reach the staff via email at

    Here are the steps you need to take:

    1. INSTRUCTIONS: Read the ATS Portal instructions for setting up your username and password and completing the required forms.

    2. ACCESS THE ATS PORTAL: Log in to the ATS Portal and complete all of the required information by July 15.

    3. PHYSICAL EXAM: All freshman and transfer athletes need to have a sports medicine physical completed and uploaded to ATS. This physical form can be downloaded from the ATS portal in the eFiles tab. Print it out and take it along to your physical exam. Once it is filled out by the doctor, you can upload it back into ATS.

    4. PERSONAL HEALTH INSURANCE CARDS: You will have to upload a photo or a scan of the front and back of your insurance card. Please bring copies of the front and back of your insurance card with you to campus as well. Take the copies of your card with you to your athlete screening session in case there are questions.

    5. ASTHMA: For athletes with documented asthma, bring us a duplicate of your inhaler with a script from your doctor.