Jump to navigation

Skip to main content

  • myMILLIKIN
  • Find Info For
    • Prospective Students
    • International Students
    • Parents & Family
    • Current Students
    • Faculty & Staff
  • Give
  • Back to Millikin.edu
  • Prospective Students
  • International Students
  • Parents & Family
  • Current Students
  • Faculty & Staff
  • MyMILLIKIN
  • Apply
  • COVID-19
  • Request Info
Millikin LogoMillikin Logo Mobile

Search form

  • Admission & Aid
    • Campus Virtual Tour

      • Millikin YouVisit Virtual Tour

    • Undergraduate
      • Why Study at Millikin?
      • Cost & Aid
      • How to Apply
      • After Acceptance
      • Meet Your Counselor
    • Visit Information
      • Virtual Tour
      • Campus Maps
      • Area Information
      • Office of Admission
    • Admissions info for...
      • First-Year Student
      • Transfer
      • International
      • Graduate Programs
      • Flexible Learning
  • Academics
    • Areas of Study

      • Millikin Students

    • Colleges and Schools
      • College of Arts & Sciences
      • College of Fine Arts
      • Professional Studies
      • Tabor School of Business
      • Interdepartmental
    • More Programs
      • Graduate Programs
      • Flexible Learning
      • Pre-Professional
      • English Language/ESL
      • Study Abroad
    • Student Resources
      • Staley Library
      • Registrar
      • Academic Resources
      • International Education
      • Academic & Professional Performance
  • Athletics
  • Campus Life
    • Residence Life

      • Residence Life

    • Activity
      • Calendar of Events
      • Arts@Millikin
      • Student Organizations
      • Black History Month
      • Kirkland Fine Arts Center
    • Student Life
      • Health & Wellness
      • Centers & Facilities
      • Campus Involvement
      • Dining
      • Residence Life
    • Services
      • Student Handbook
      • Public Safety
      • Information Technology
      • Academic & Professional Performance
      • Student Financial Services
  • Alumni & Friends
    • Get Involved
      • Alumni Building
    • Stay Connected
      • Alumni News
      • Millikin Magazine
      • Alumni Directory
      • Featured Alumni
      • Resources
    • Alumni Events
      • Alumni Calendar
      • Homecoming
      • Goodheart Event
      • Founder's Day
      • Lindsay Medallion
    • Give To MU
      • Give
      • Ways to Give
      • Millikin Fund
      • Big Blue Club
      • Patrons Society
  • About
    • Faculty & Staff Directory

      • Shilling Hall

    • At A Glance
      • Mission & Values
      • COVID-19 Info
      • Employment
      • Accreditation
      • Consumer Information
    • Administration
      • Office of the President
      • Office of the Provost
      • Student Affairs
      • Board of Trustees
      • Faculty & Staff Directory
    • Marketing & Media
      • Newsroom
      • Calendar of Events
      • University Marketing
      • Video Gallery
      • Press Kit
search iconmobile search icon
Menu
  • Admission & Aid
    • Campus Virtual Tour
      • Undergraduate
        • Why Study at Millikin?
        • Cost & Aid
        • How to Apply
        • After Acceptance
        • Meet Your Counselor
      • Visit Information
        • Virtual Tour
        • Campus Maps
        • Area Information
        • Office of Admission
      • Admissions info for...
        • First-Year Student
        • Transfer
        • International
        • Graduate Programs
        • Flexible Learning
    • Academics
      • Areas of Study
        • Colleges and Schools
          • College of Arts & Sciences
          • College of Fine Arts
          • Professional Studies
          • Tabor School of Business
          • Interdepartmental
        • More Programs
          • Graduate Programs
          • Flexible Learning
          • Pre-Professional
          • English Language/ESL
          • Study Abroad
        • Student Resources
          • Staley Library
          • Registrar
          • Academic Resources
          • International Education
          • Academic & Professional Performance
      • Athletics
      • Campus Life
        • Residence Life
          • Activity
            • Calendar of Events
            • Arts@Millikin
            • Student Organizations
            • Black History Month
            • Kirkland Fine Arts Center
          • Student Life
            • Health & Wellness
            • Centers & Facilities
            • Campus Involvement
            • Dining
            • Residence Life
          • Services
            • Student Handbook
            • Public Safety
            • Information Technology
            • Academic & Professional Performance
            • Student Financial Services
        • Alumni & Friends
          • Get Involved
            • Stay Connected
              • Alumni News
              • Millikin Magazine
              • Alumni Directory
              • Featured Alumni
              • Resources
            • Alumni Events
              • Alumni Calendar
              • Homecoming
              • Goodheart Event
              • Founder's Day
              • Lindsay Medallion
            • Give To MU
              • Give
              • Ways to Give
              • Millikin Fund
              • Big Blue Club
              • Patrons Society
          • About
            • Faculty & Staff Directory
              • At A Glance
                • Mission & Values
                • COVID-19 Info
                • Employment
                • Accreditation
                • Consumer Information
              • Administration
                • Office of the President
                • Office of the Provost
                • Student Affairs
                • Board of Trustees
                • Faculty & Staff Directory
              • Marketing & Media
                • Newsroom
                • Calendar of Events
                • University Marketing
                • Video Gallery
                • Press Kit

            Forms

            Millikin DMH Health Clinic

            You are here

            1. Home
            2. Campus Life
            3. Health & Wellness
            4. Millikin-Memorial Clinic
            5. Forms

            Forms

            Millikin DMH Health Clinic Forms

            • Health Service Report Form (right click and save to desktop to fill in blanks)
            • Immunization Form (right click and save to desktop to fill in blanks)
            • Religious Exemption

            Health & Wellness

            • Millikin-Memorial Clinic
              • Emergency Contacts
              • Forms
              • Medical
              • Meet the Staff
              • Vaccination Policy
              • Seasonal Influenza
            • COVID-19 Info
              • Campus Messages
              • Campus Operations
              • Current Students
              • Employees
              • FAQs
              • Prospective Students
              • Resources
                • Student Emergency Support Funds
            • Counseling
              • Meet the Staff
            • Stay Healthy and Fit
            • Intramural Sports
            • Calendar
            • Arts@Millikin
            • Staley Library
            • Directory
            • Kirkland Fine Arts Center
            • Employment
            • Centers & Facilities
            • Accessibility
            • Newsroom
            • Contact Us
            • Campus Maps
            • Title IX Reporting
            Millikin Footer Logo
            1184 W. Main St.
            Decatur, IL 62522
            800.373.7733
            Email Contact Form
            • Facebook
            • Twitter
            • Instagram
            • YouTube
            • Linkedin
            • Medium

            Site Pixel - All Site

            Site Pixel Tracking Code

            Copyright © 2019 Millikin University. All Rights Reserved.

            • Online Complaint Form
            • Feedback
            • Privacy Policy
            • Sitemap