*Required fields are marked with an asterisk.
to Rose-Hulman Health Services Patient Portal! We strive to offer our patients convenient, high-quality care. One of the ways we want to do this is by offering our patients online health services through our website. These services are now available through
this secure patient website.
Rose-Hulman Health Services welcomes you to Rose-Hulman Institute of Technology. We are a team Medical Staff and Counseling Staff. We provide health and counseling services on campus to registered students. The Accident and Sickness Insurance
Plan offered by Rose-Hulman is not
to use these services.
The necessary new student health forms are located under the New Student Forms tab. Failure to complete and return these medical documents will jeopardize your following quarter registration. These forms are also available online at
To access the secure patient website and submit your forms electronically you will need to register and enter your temporary password. Your temporary password will arrive in a separate email. Below is a list of forms.
Required Health Documents Checklist
Rose-Hulman Institute of Technology Physical Examination Form - Return completed form to Health Services Office
Rose-Hulman Institute of Technology Student Health Services Immunization & Screening Form - Return completed form to Health Services Office
Rose-Hulman Information Sheet & Medical Consent Form
Patient Privacy Consent Form
All forms should be completed and returned to the Health Services Office by August
Students who plan to attend Fast Track Calculus or PHAST Physics are required to have all forms returned to Health Services by the time they arrive on campus.
If completing the forms electronically, they are automatically sent to us with the exception of the two forms requiring a physician signature. Those two forms (RHIT Physical Exam & RHIT Immunization & Screening) will need mailed back
This important information will allow us to provide you with the best possible health care and be in compliance with State/Federal Law.
If you have any questions, please contact our office at:
(812) 877-8367 / fax (812)872-6225
/ 5500 Wabash Ave.
Terre Haute, IN 47803
We are looking forward to seeing you on campus.
Current Students and
Services include online appointment scheduling, medical record access (limited), the ability to send a secure electronic message to your doctor, and more. If you are interested in learning more about our innovative clinic, please contact UAP Clinic
or (812) 877-8367 or Stop by Health Services to be issued your Personal Identification Number needed to complete your registration process. To protect your privacy these PIN numbers are only issued in person; identification required.
If you need Technical Support for issues using the website we have a guide that can walk you through the setup process
or you can contact us at
If you have a Customer Service experience that you would like to share concerning our facilities, staff, or services, please
let us know by emailing us
. We will always strive to exceed your expectations!