Health Information Forms
All students taking 4 or more credit hours are required by law to provide record of immunizations prior to the start of classes*. Please note that failure to provide proof of immunization prior to the start of classes may result in administrative withdrawal from the university until the form is complete.
Additional information on the health form is utilized by Health Services and by the Athletic Training Office for those who are student athletes. Pages 2 and 3 of the form must be completed by a physician.
Students entering Pfeiffer University in the fall semester are asked to have this completed form to Health Services no later than July 1.
Return completed forms to:Pfeiffer UniversityAdmissions DepartmentP. O. Box 960Misenheimer, NC 28109
Forms may also be faxed to Health Services at (704) 463-1361.
Download the Health Information Form
* Students are exempt from the mandatory immunization reporting if:
- the student is registered ONLY in off-campus courses
- the student attends night or weekend classes ONLY
- the student takes a course load of less than 4 credit hours AND resides off-campus
Health History FormThis form must be completed by July 1st. Your physician must fill out pages 2 and 3 of this form.
- Download a PDF of the Health History Form
Attn: Health Services
P.O. Box 960
Misenheimer, NC 28109
All medical records of services received in Health Services are confidential. Information is not released without the student's permission. Students are encouraged to notify their parents of illness or injury, but the University staff will notify parents only with the student's permission or in the event of serious illness or injury.
For further details regarding the handling of your health information, please see our Notice of Privacy Practices
Health Insurance-Misenheimer Students
University policy requires that all students taking 12 or more credits each semester be covered under a health insurance policy. Health insurance coverage may be offered through personal or parental employers or via private personal policies (Medicare, hospitalization, major medical).
We are pleased to be able to offer our students a true major medical insurance plan through Blue Cross Blue Shield of North Carolina for 2013-14. Every Pfeiffer student with 12 or more credits will be charged for health insurance on his/her university bill.
Charges are assigned via a hard waiver process. Your student account is charged for the StudentBlue plan premium until you waive (decline) or enroll (accept) the coverage. Students are not covered by the policy until the enrollment has been confirmed.
If you have existing health coverage, you may complete an online waiver that will remove the premium charge from your student account. If you need this health coverage, you must confirm your enrollment online as well.
The open enrollment/waiver period for fall semester begins July 12, 2013 and will end August 30, 2013.
Please check the email account on file with the university for further instructions and information regarding this process. Any student who fails to confirm enrollment or waive coverage by established deadline will be enrolled by default and no refund of premium will be allowed. Enrollment/waiver period start and ending dates will published here and via the email sent to students.
To insure international students have basic health insurance benefits while enrolled at Pfeiffer University, all international full-time undergraduate students on the Misenheimer campus are required to enroll in the University-contracted health insurance policy. Students may choose to secure additional accident/illness coverage from other vendors at their discretion.
Upon request, University staff will review an international policy to determine if it will be accepted by providers in the US. If the coverage is verified, a waiver of the university sponsored policy will be accepted.
Important Notice for Student Athletes
The BCBS Student Blue plan does not cover athletic injuries. The Athletic Training staff has secured a separate athletic injury policy through First Agency for student athletes who will need to enroll in the Student Blue plan. Please contact the athletic training office (704-463-3215) for further information about the First Agency athletic injury coverage.
For Policy Information or to Waive or Confirm Enrollment
Go to BCBS StudentBlue. For issues logging into the BCBS website, contact Blue Cross Blue Shield at 1-800-579-8022.
Nurse Practitioner Jenny Carrick joined the Pfeiffer University community in 2011 to provide on-site medical care to students, faculty and staff. She is available Mon.-Fri., 8:30 a.m.-2:30 p.m. in Health Services, Stokes Student Center, Room 121.
Ms. Carrick, who holds a B.S. in Nursing from UNC Chapel Hill and an M.S. in Nursing and an Adult Nurse Practitioner degree from UNC Charlotte, comes to Pfeiffer with surgery, intensive care unit and family practice experience.
As a nurse practitioner, she is licensed to order, perform and interpret diagnostic tests such as lab work and x-rays; diagnose and treat acute and chronic conditions, including infections and injuries; prescribe medications and other treatments; counsel patients about how to improve their health and help them understand how their decisions affect their health and well-being.
All students, whether commuting or residential, full or part-time, may utilize the services available.